Liver retransplantation in adults: a single-centre, 25-year experience.
BACKGROUND
Retransplantation is the only form of treatment for patients with irreversible graft failure. The aim of this study was to analyse a single centre's experience of the indications for and outcomes of retransplantation.


METHODS
A total of 196 patients who underwent liver retransplantation using 225 grafts, between January 1982 and July 2007, were included in the study. The following parameters were analysed: patient demographics; primary diagnosis; distribution of retransplantation over different time periods; indications for retransplantation; time interval to retransplantation, and overall patient and graft survival.


RESULTS
Of the 2437 primary orthotopic liver transplantations, 196 patients (8%) required a first regraft, 23 patients (1%) a second regraft and six patients (0.25%) a third regraft. Autoimmune hepatitis was the most common primary diagnosis for which retransplantation was required (12.7% of primary transplantations). The retransplantation rate declined from 12% at the beginning of our programme to 7.6% at the end of the study period. The most common indication for retransplantation was hepatic artery thrombosis (31.6%). Nearly two-thirds of the retransplantations were performed within 6 months of the primary transplantation. The 1-, 3-, 5- and 10-year patient survival rates following first retransplantation were 66%, 61%, 57% and 47%, respectively. Five-year survival after second retransplantation was 40%. None of the patients have yet survived 3 years after a third regraft. Donor age of < or =55 years and a MELD (Model for End-stage Liver Disease) score of < or =23 were associated with better outcome following retransplantation.


CONCLUSIONS
First retransplantation was associated with good longterm survival. There was no survival benefit following second and third retransplantations. A MELD score of < or =23 and donor age of < or =55 years correlated with better outcome following retransplantation.
Marudanayagam
Ravi
R
Liver Unit, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
Shanmugam
Vivekanandan
V
Sandhu
Bynvant
B
Gunson
Bridget K
BK
Mirza
Darius F
DF
Mayer
David
D
Buckels
John
J
Bramhall
Simon R
SR
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D006084:Graft Rejection; D006499:Hepatic Artery; D019693:Hepatitis, Autoimmune / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D013927:Thrombosis / Q000601:surgery; D014019:Tissue Donors