title: Intercurrent infection predicts mortality in patients with late hepatic artery thrombosis listed for liver retransplantation.
abstract: Liver retransplantation for late hepatic artery thrombosis (HAT) is considered the treatment of choice for select patients. Nevertheless, there is a paucity of data to aid decision making in this setting. The aims of this single-center study of patients listed for late HAT were (1) to determine variables associated with wait-list mortality, (2) to describe survival after retransplantation, and (3) to determine variables associated with mortality after retransplantation. Seventy-eight patients were diagnosed with late HAT (incidence = 3.9%). Of the 49 patients listed for retransplantation, 9 died on the waiting list and 36 were retransplanted. The estimated 1-year survival after listing for retransplantation was 53.7%. Only multidrug-resistant (MDR) bacteria-positive cultures were predictive of wait-list mortality (P = 0.01). After retransplantation, the estimated 1- and 5-year patient survival was 71.9% and 62.5%, respectively. Increasing Model for End-Stage Liver Disease score (overall P = 0.007), MDR bacteria-positive cultures (P = 0.047), and continued antibiotic therapy (P = 0.001) at the time of retransplantation were risk factors for post retransplant death. In conclusion, patients who undergo liver retransplantation for late HAT have satisfactory outcomes. However, the presence of active infection and MDR bacteria-positive cultures should be taken into account when risk stratifying such patients.
authors: Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom; National Institute for Health Research Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, United Kingdom. j.a.leithead@bham.ac.uk
authors: Joanna Agnes
authors: JA
authors: Leithead
authors: Matthew R
authors: MR
authors: Smith
authors: Luke B
authors: LB
authors: Materacki
authors: Vandana M
authors: VM
authors: Sagar
authors: Bridget K
authors: BK
authors: Gunson
authors: Simon R
authors: SR
authors: Bramhall
authors: David J
authors: DJ
authors: Mutimer
authors: Tahir
authors: T
authors: Shah
mesh_terms: D000328:Adult; D005260:Female; D005919:Glomerular Filtration Rate; D006499:Hepatic Artery / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000098:blood supply; D008107:Liver Diseases / Q000150:complications / Q000382:microbiology; D017093:Liver Failure / Q000401:mortality* / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000382:microbiology* / Q000401:mortality*; D016896:Treatment Outcome