title: Liver retransplantation of more than two grafts for recurrent failure.
abstract: BACKGROUND
  Transplantation of more than two livers for recurring graft failure has not been specifically addressed in the literature.
  
  
  METHODS
  A retrospective analysis was conducted from a total of 2527 overall liver transplants at our institution. Main indications for multiple retransplant included primary nonfunction, chronic rejection, hepatic artery thrombosis, and recurrent disease.
  
  
  RESULTS
  We identified 39 patients who received more than two grafts (32 received 3 grafts, 5 received 4 grafts, and 2 received 5 grafts). All patients required interposition arterial grafts from the aorta and hepatojejunostomy for the biliary reconstruction. Seventeen patients are still alive at last follow-up. Perioperative mortality rates after 3rd, 4th, and 5th liver graft were 25%, 14%, and 50%, respectively. Patient and graft survival rates were 72% and 56% at 1 year, respectively. Median length of stay was 27 days and median graft survival was 2.9 years.
  
  
  CONCLUSIONS
  Selection of patients and a significant use of available resources are some of the important factors that clinicians need to take into account when dealing with multiple retransplantations. With such conditions, however, liver retransplantation of more than two grafts can be a life-saving procedure.
authors.affiliation: Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
authors.forename: Edip
authors.initials: E
authors.lastname: Akpinar
authors.forename: Gennaro
authors.initials: G
authors.lastname: Selvaggi
authors.forename: David
authors.initials: D
authors.lastname: Levi
authors.forename: Jang
authors.initials: J
authors.lastname: Moon
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: Eddie
authors.initials: E
authors.lastname: Island
authors.forename: Werviston
authors.initials: W
authors.lastname: DeFaria
authors.forename: Ernesto
authors.initials: E
authors.lastname: Pretto
authors.forename: Philip
authors.initials: P
authors.lastname: Ruiz
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis
mesh_terms: D000328:Adult; D002648:Child; D005704:Gallbladder / Q000601:surgery; D006085:Graft Survival; D006509:Hepatitis B / Q000601:surgery; D006526:Hepatitis C / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D010349:Patient Compliance; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods / Q000706:statistics & numerical data; D012008:Recurrence; D012086:Reoperation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors; D017211:Treatment Failure; D016896:Treatment Outcome