Preliminary clinical experience in liver retransplantation.
BACKGROUND
The past several decades have witnessed increasingly successful rates of liver transplantation. However, retransplantation remains the only choice for patients with irreversible graft failure after primary transplantation. This article aimed to summarize our clinical experience in liver retransplantation.


METHODS
From June 2002 to December 2005, a total of 185 cases of liver transplantation including 8 cases of retransplantation were performed in our hospital. The clinical data were analyzed retrospectively.


RESULTS
The rate of liver retransplantation was 4.32%. Retransplantation was indicated for the following reasons: biliary complication (3 cases), chronic rejection (2), hepatic artery thrombosis (1), uncontrollable acute rejection (1) and hepatitis B recurrence (1). The mean model of end-stage liver disease (MELD) scores before primary transplantation and retransplantation were 15.6 and 23.9, respectively (P<0.05). The MELD score reflected the severity of liver disease more precisely than the Child classification. The mean interval between the first and second transplantation was 316 days (78-725 days). The first three patients, with mean interval of 101 days, died of severe infection combined with multiple organ failure after retransplantation. The patients who underwent retransplantation more than six months after the first transplant had better outcomes. The one-year survival rate for retransplantation in our group was 62.5%.


CONCLUSIONS
Liver retransplantation is the only means of saving the patient with hepatic allograft failure. Understanding of the indications for retransplantation, careful selection of operation timing, excellent surgical skills and meticulous postoperative management all contribute to the success of each case of retransplantation.
Yan
Ji-Qi
JQ
Department of Surgery, Centre of Organ Transplantation, Ruijin Hospital, Medical School of Jiaotong University, Shanghai, China.
Peng
Cheng-Hong
CH
Li
Hong-Wei
HW
Shen
Bai-Yong
BY
Zhou
Guang-Wen
GW
Yang
Wei-Ping
WP
Chen
Hao
H
Chen
Yong-Jun
YJ
Shen
Chuan
C
D000328:Adult; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome