title: Have we changed the liver retransplantation survival?
abstract: BACKGROUND
  Orthotropic liver retransplantation (RT) is the therapeutic option for the failure of an allograft. Patient and graft survival rates after RT are inferior to primary liver transplantation (OLT). Because of the limited number of donors, it is essential that we optimize their use. We reviewed 68 consecutive retransplantations to evaluate their results.
  
  
  METHODS
  Using registry data from our Liver Transplantation Unit, we performed a retrospective cohort study of adult RT between 1991 and 2010. Patients were divided into 2 groups (urgent vs elective RT) to compare the utility of RT. We also analyzed data collected at the time of RT, including age, gender, indications for primary OLT and RT (hepatitis C virus [HCV]+ and HCV-). At various stages (1991-2000, 2001-2006, and 2007-2010), we calculated probability survival curves according to the Kaplan-Meier method with comparisons using the log-rank test.
  
  
  RESULTS
  Among 771 adult liver transplantations, 68 (8.8%) underwent late secondary OLT. 21 (31%) cases were urgent and 47 elective RT (69%). Vascular complications was the most common cause for urgent RT, and chronic rejection, for elective RT. Differences were also detected in the overall survival of RT patients; mortality was significantly lower among the urgent procedures (15% vs 47.8%). Significantly differences were also detected in overall survival for RT patients between 2007 and 2010 (81.7% with urgent RT and 76.5% with elective situations).
  
  
  CONCLUSIONS
  These data confirmed the utility of RT in elective and emergency situations. Overall survival of elective RT patients has improved in recent years. Liver RT requires a multidisciplinary team to decide the inclusion and prioritization of elective RT cases on the OLT waiting list.
authors: Liver Transplantation Unit, Surgery Department, Virgen del Rocío Hospital, Sevilla, Spain. cbernalb@hotmail.com
authors: C B
authors: CB
authors: Bellido
authors: J M Á
authors: JM
authors: Martínez
authors: G S
authors: GS
authors: Artacho
authors: L M M
authors: LM
authors: Gómez
authors: J S
authors: JS
authors: Diez-Canedo
authors: L B
authors: LB
authors: Pulido
authors: J M P
authors: JM
authors: Acevedo
authors: J P
authors: JP
authors: Ruiz
authors: M A G
authors: MA
authors: Bravo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D017211:Treatment Failure; D055815:Young Adult