title: Liver retransplantation in adults: a 20-year experience of one center in southern Brazil.
abstract: BACKGROUND
  Liver retransplantation (LReTx) is the therapeutic option for hepatic graft failure. Survival after LReTx is poorer than after primary liver transplantation. Given the organ shortage, it is essential to optimize the use of this resource.
  
  
  OBJECTIVE
  To evaluate rates, indications and patient survival after LReTx and identify factors associated with mortality following LReTx.
  
  
  METHODS
  We conducted a retrospective cohort study of all adults undergoing LReTx based on registry data from the Liver Transplantation Group (Complexo Hospitalar Santa Casa de Porto Alegre), southern Brazil.
  
  
  RESULTS
  Between June 16, 1991 and July 19, 2011, 824 patients underwent 866 liver transplants. Forty-two procedures corresponded to LReTx (4.8% of all liver transplants performed). Thirty-eight patients who underwent a single LReTx procedure were included in this study. The leading indication for LReTx was hepatic artery thrombosis (HAT) (31.6%), followed by primary nonfunction (PNF) (18.4%). The main indication for early LReTx was PNF (58.3%) and for late LReTx was HAT (38.5%). During the follow-up period, 26 patients (68.4%) died after LReTx. Patient survival at 1 and 3 years after LReTx was 44.7% and 44.7%, respectively. Patients infected with hepatitis C virus, serum albumin < 2.5 g/dL and receiving mechanical ventilation immediately before LReTx had a significantly lower survival rate than the other patients.
  
  
  CONCLUSIONS
  Considering the increased mortality when the graft loss is delayed, it is necessary to define the minimum acceptable results to indicate LReTx and identify the patients who would most benefit from this treatment.
authors.affiliation: Post-Graduate Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
authors.forename: Ane Micheli
authors.initials: AM
authors.lastname: Costabeber
authors.forename: Marioni
authors.initials: M
authors.lastname: Granzotto
authors.forename: Alfeu de Medeiros
authors.initials: Ade M
authors.lastname: Fleck
authors.forename: Cláudio Augusto
authors.initials: CA
authors.lastname: Marroni
authors.forename: Maria Lúcia
authors.initials: ML
authors.lastname: Zanotelli
authors.forename: Guido
authors.initials: G
authors.lastname: Cantisani
authors.forename: Lívia
authors.initials: L
authors.lastname: Lionço
authors.forename: Maiara Isabel
authors.initials: MI
authors.lastname: Musskopf
authors.forename: Ajácio
authors.initials: A
authors.lastname: Brandão
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001938:Brazil; D002648:Child; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; 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*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult