title: Retransplantation of the liver in adults: long-term outcome and prognostic modeling.
abstract: OBJECTIVE
  The purpose of this study was to assess the outcome of liver retransplantation in adults at our institution and identify the subset of patients in which the outcome was too poor to justify retransplantation.
  
  
  METHODS
  Over a 12-year period, we performed 346 liver transplantations in 305 adult patients, and of these, 41 (11.8%) were retransplantations. Survival data were stratified and multivariate analysis was conducted to identify variables associated with poor outcome after retransplantation.
  
  
  RESULTS
  The 90-day, 1-year, and 5-year survival rates after liver retransplantation were 65.9%, 62.6%, and 48.2%, respectively. These rates were significantly inferior compared to those following single liver transplantation. Major adverse events affecting patient survival after retransplantation occurred within the first 90 days after surgery. Three independent prognostic variables of patient survival after retransplantation were identified: preoperative coagulation factor, total bilirubin, and the need for preoperative dialysis. Using these variables, we defined a simplified mathematical model available at the time of decision of retransplantation.
  
  
  CONCLUSIONS
  The present study indicated three important prognostic factors associated with a poor outcome after retransplantation. Based on our newly developed scoring-system estimating patient survival, we suggest that retransplantation must be indicated before the deterioration of more than two organs. These findings should assist in the decision process for liver retransplantation in adult patients.
authors.affiliation: Second Department of Surgery, Fukuoka University School of Medicine, Fukuoka, Japan. yyama@fukuoka-u.ac.jp
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yamauchi
authors.forename: Andre
authors.initials: A
authors.lastname: Wettergren
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Koji
authors.initials: K
authors.lastname: Mikami
authors.forename: Masanobu
authors.initials: M
authors.lastname: Hyodo
authors.forename: Peter Norgaard
authors.initials: PN
authors.lastname: Larsen
authors.forename: Allan
authors.initials: A
authors.lastname: Rasmussen
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shirakusa
authors.forename: Preben
authors.initials: P
authors.lastname: Kirkegaard
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D011379:Prognosis; D012086:Reoperation / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome