title: Outcome of liver re-transplantation in children--impact and special analysis of early re-transplantation.
abstract: In case of graft failure, re-LTX is the only life-saving option but it has been associated with inferior results. This study analyzes the outcome following pediatric re-LTX with a main focus on the timely relation between initial transplant and re-LTX. All pediatric LTX at our institution between 2000 and 2010 divided into patients with primary LTX and patients undergoing re-LTX early (≤30 days) or late (>30 days) after previous LTX were analyzed. Two hundred and ninety-eight primary LTX(79%), 33 early (9%), and 46 late (12%) re-LTX were performed. Patient/graft survival was significantly worse for children undergoing early re-LTX compared to primary LTX and late re-LTX (p = 0.024/0.001 and p = 0.015/0.03). One-/five-yr graft survival rates were 66%/49% for early re-LTX compared to 86%/76% for late re-LTX and 90%/74% for primary LTX. The inferior results in children undergoing early re-LTX were due to events occurring in the first six months with similar survival thereafter. No difference in outcome was evident after adjustment of the groups for high-urgency status. Outcome was excellent for primary LTX and late re-LTX, supporting late re-LTX in children. Early re-LTX takes an elevated risk of early graft loss and patient death; however, beyond the early postoperative period, the outcome was comparable.
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Uta
authors.initials: U
authors.lastname: Herden
authors.forename: Rainer
authors.initials: R
authors.lastname: Ganschow
authors.forename: Enke
authors.initials: E
authors.lastname: Grabhorn
authors.forename: Andrea
authors.initials: A
authors.lastname: Briem-Richter
authors.forename: Bjoern
authors.initials: B
authors.lastname: Nashan
authors.forename: Lutz
authors.initials: L
authors.lastname: Fischer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000379:methods / Q000401:mortality*; D008297:Male; D063868:Patient Outcome Assessment; D012086:Reoperation / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
keywords: liver transplantation; pediatric; re-transplantation