title: Optimization of liver grafts in liver retransplantation: a European single-center experience.
abstract: BACKGROUND
  Liver retransplantation (ReLT) is the only therapeutic option that offers a chance at long-term survival when a liver graft fails. Careful analysis of the results and potential benefits is needed to justify its role in the current era of donor shortage and economical concerns. We reviewed all retransplants performed in our hospital and tried to determine if there is a high risk group of patients in whom its use would be contraindicated.
  
  
  METHODS
  Between June 1988 and January 2006, 1,226 liver transplants were performed in 1,118 patients at our institution. Among them, 108 retransplants (8.8%) were performed in 98 patients. Preoperative, intraoperative, and postoperative data were gathered from our prospectively collected liver transplant database. The entire series of patients was divided between two periods of equal duration and patients were also classified according to the interval between retransplantation and the previous transplant.
  
  
  RESULTS
  Concerning indications, only chronic rejection was a more frequent etiology in the first period versus the second period. When comparing first and second periods, 1-, 5-, and 10-year graft survival was 66%, 45%, and 40% and 76%, 69%, and 69%, respectively (P = .014). No significant differences in post-ReLT survival were found when the indication was HCV recurrence versus other non-urgent causes (1-, 5-, and 10-year graft survival: 70%, 57%, and 57% vs 72%, 50%, and 45%). According to the UNOS Rosen risk score, patients in the low-risk group showed significantly greater survival with respect to patients in the high-risk group though 5-year survival in the high-risk group was still greater than 50%.
  
  
  CONCLUSIONS
  ReLT indications have changed over time, with better results being achieved in more recent years. Candidate selection in elective ReLT is critical to improve the results, though current criteria do not allow for the identification of a single patient subset in which ReLT would be contraindicated.
authors.affiliation: Liver Transplant Unit, Institut Clínic de Malalties Digestives i Metabolisme, Hospital Clínic i Provincial, CIBERehd, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Martí
authors.forename: Ramón
authors.initials: R
authors.lastname: Charco
authors.forename: Joana
authors.initials: J
authors.lastname: Ferrer
authors.forename: David
authors.initials: D
authors.lastname: Calatayud
authors.forename: Antoni
authors.initials: A
authors.lastname: Rimola
authors.forename: Miquel
authors.initials: M
authors.lastname: Navasa
authors.forename: Constantino
authors.initials: C
authors.lastname: Fondevila
authors.forename: Josep
authors.initials: J
authors.lastname: Fuster
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: García-Valdecasas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D000075202:Contraindications; D005260:Female; D006085:Graft Survival; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017211:Treatment Failure; D055815:Young Adult