title: Early liver retransplantation versus late liver retransplantation: analysis of a single-center experience.
abstract: BACKGROUND
  Orthotopic liver retransplantation (re-OLT) is the only effective therapy for irreversible failure of a liver graft. Early and late graft failure gives way to two different clinical conditions that should be discussed separately. This study was designed to compare early and late re-OLT for patients with poor graft function after primary transplantation at our center and sum up our clinical experience in re-OLT.
  
  
  METHODS
  The clinical data of 31 re-OLTs at our center from January 2004 to February 2007 were analyzed retrospectively, consisting of the first group with 14 cases of early re-OLT and the second group with 17 cases of late re-OLT.
  
  
  RESULTS
  Biliary tract complications were the main indications for early re-OLT (57.1%) and late re-OLT (52.9%). Other common indications were vascular complications in early re-OLT and recurrence of primary diseases in late re-OLT. No significant differences were found between the groups with regard to the volume of bleeding during operation, cold ischemia time, operative duration, and perioperative mortality; except for the model of end-stage liver disease (MELD) score. Outcome was fatal for 7 patients in early re-OLT and 9 patients in late re-OLT. Two deaths were due to multiple organ failure with 3 deaths due to severe sepsis-related disease in early re-OLT, and 4 deaths were due to severe sepsis-related disease with 3 deaths due to recurrence of hepatocellular carcinoma (HCC) in late re-OLT. One and 2-year actuarial survival rates after re-OLT were 55.2% and 36.9%, respectively, for patients in early re-OLT, and 65.1% and 52% respectively, for patients in late re-OLT. No significant differences were found regarding survival rates between the two groups.
  
  
  CONCLUSIONS
  Similar clinical results can be achieved in early and late re-OLT. Proper indications and optimal operation timing, adequate preoperative preparation, experienced surgical procedures, and effective perioperative anti-infection strategy contribute to the improvement of overall survival rates of patients after re-OLT.
authors.affiliation: Liver Transplantation Center, Third Affiliated Hospital of Sun Yat-sen University, Transplantation Research Institute of Sun Yat-sen University, Guangzhou, Guangdong 510630, China. chgh1955@163.com
authors.forename: Gui-hua
authors.initials: GH
authors.lastname: Chen
authors.forename: Bin-sheng
authors.initials: BS
authors.lastname: Fu
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.forename: Chang-jie
authors.initials: CJ
authors.lastname: Cai
authors.forename: Min-qiang
authors.initials: MQ
authors.lastname: Lu
authors.forename: Hua
authors.initials: H
authors.lastname: Li
authors.forename: Gen-shu
authors.initials: GS
authors.lastname: Wang
authors.forename: Shu-hong
authors.initials: SH
authors.lastname: Yi
authors.forename: Chi
authors.initials: C
authors.lastname: Xu
authors.forename: Jun-feng
authors.initials: JF
authors.lastname: Zhang
authors.forename: Tong
authors.initials: T
authors.lastname: Zhang
authors.forename: Guo-ying
authors.initials: GY
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D015996:Survival Rate; D013997:Time Factors