title: Risk factors in liver retransplantation: a single-center experience.
abstract: Liver retransplantation (Re-OLT) is one of the most debated issues in medicine over the past decade. Re-OLT, currently is accepted for patients with irreversible failure of a hepatic graft caused by primary nonfunction (PNF), hyperacute/chronic rejection, or hepatic artery thrombosis (HAT); whereas it is still controversial for patients with recurrent viral disease, in particular hepatitis C virus (HCV) cirrhosis. Patient and graft survival rates are lower than those observed after primary liver transplantation (OLT). The aim of the present study was to analyze the risk factors that adversely affect survival after Re-OLT in a single center. Medical data were collected for 23 patients who underwent Re-OLT from November 2002 to December 2008 including six men and seven women of mean age of 51.3 years. The most frequent indications for Re-OLT were: PNF (69.5%; 16/23), HCV recurrence (8.6%; 2/23), or HAT (8.6%; 2/23). Mean Model for End-Stage Liver Disease (MELD) at Re-OLT was 27.7 (range = 9-40). After a mean follow-up of 37.4 ± 30 (standard deviation) months, 43% (10/23) of patients had died, including 70% within the first 2 months after Re-OLT. Sepsis represented the commonest cause of death (40%). Re-OLT was performed for PNF among 90% of succumbing patients. As regards dead patients, 4/10 were HCV(+) whose causes of death were sepsis (n=2), alcoholic cirrhosis (n=2), and undetermined (n=1). Comparing patients who died after liver Re-OLT versus alive patients, we did not find any significant difference in terms of mean MELD (28.6 vs 27; P=NS), MELD > 25 (60% vs 61.5%, P=NS), donor age > 60 years (30% vs 15.3%, P=NS), HCV(+) (40% vs 62%, P = NS), or time interval from OLT to Re-OLT (12.2 vs 777.7 days, P=NS). Patient survivals after Re-OLT were 67% at 3 years and 50% at 5 years, which were lower than those of first transplantations, as reported by other European and International Centers. Forty percent of deaths after Re-OLT occurred among HCV(+) recipients, but for reasons unrelated to HCV infection.
authors.affiliation: Multivisceral Transplant Unit, Department of Surgical and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Crivellin
authors.forename: E
authors.initials: E
authors.lastname: De Martin
authors.forename: G
authors.initials: G
authors.lastname: Germani
authors.forename: M
authors.initials: M
authors.lastname: Gambato
authors.forename: M
authors.initials: M
authors.lastname: Senzolo
authors.forename: F P
authors.initials: FP
authors.lastname: Russo
authors.forename: A
authors.initials: A
authors.lastname: Vitale
authors.forename: G
authors.initials: G
authors.lastname: Zanus
authors.forename: U
authors.initials: U
authors.lastname: Cillo
authors.forename: P
authors.initials: P
authors.lastname: Burra
mesh_terms: D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D002423:Cause of Death; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D005260:Female; D006085:Graft Survival; D006499:Hepatic Artery / Q000601:surgery*; D006526:Hepatitis C / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology / Q000401:mortality; D015996:Survival Rate; D013927:Thrombosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D017211:Treatment Failure; D055815:Young Adult