title: Short- and long-term outcomes of third liver transplantation at single centre.
abstract: OBJECTIVE
  Although three or more liver transplantation (LT)s in the same patient arouse not only medical but also ethical issues in the context of organ shortage, it is a fact that additional liver retransplantation (reLT) is the only lifesaving treatment option for those with graft failure after a second LT. However, little is known regarding the risks and benefits associated with a third LT.
  
  
  METHODS
  We analyzed fifteen cases of third LT and 48 of second LT performed between January 2000 and December 2010. Clinical outcomes were compared with those of second LT cases performed during the same period.
  
  
  RESULTS
  Model for end-stage liver disease (MELD) scores at transplant was similar between the two groups. As for surgical aspects, there was no significant difference in operative time or number of units of red blood cells transfused during the transplant procedures between the groups. Patient and graft survival after the third LT at 1, 3, and 10 years were 66.7, 51.9, and 44.4 %, and 66.7, 51.9, and 29.6 %, respectively. There was no significant difference in patient or graft survival between the groups. However, graft loss within 3 months after the third LT was significantly higher than that of second LT patients.
  
  
  CONCLUSIONS
  Third LT cases showed acceptable short- and long-term outcomes that were not significantly inferior to those of a second LT. Careful patient care especially in the early phase after a third LT may be essential to improve the outcome.
authors.affiliation: Multi-Organ Transplant Program, University Hospital of Ontario, London Health Science Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada. kamei@med.nagoya-u.ac.jp.
authors.forename: Hideya
authors.initials: H
authors.lastname: Kamei
authors.affiliation: Multi-Organ Transplant Program, University Hospital of Ontario, London Health Science Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada.
authors.forename: Mamoun
authors.initials: M
authors.lastname: Al-Basheer
authors.affiliation: Multi-Organ Transplant Program, University Hospital of Ontario, London Health Science Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Shum
authors.affiliation: Multi-Organ Transplant Program, University Hospital of Ontario, London Health Science Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Bloch
authors.affiliation: Multi-Organ Transplant Program, University Hospital of Ontario, London Health Science Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada.
authors.forename: Roberto Hernandez
authors.initials: RH
authors.lastname: Alejandro
authors.affiliation: Multi-Organ Transplant Program, University Hospital of Ontario, London Health Science Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada.
authors.forename: Vivian
authors.initials: V
authors.lastname: McAlister
authors.affiliation: Multi-Organ Transplant Program, University Hospital of Ontario, London Health Science Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Wall
authors.affiliation: Multi-Organ Transplant Program, University Hospital of Ontario, London Health Science Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada.
authors.forename: Douglas
authors.initials: D
authors.lastname: Quan
keywords: Donor shortage; Liver retransplantation; Patient survival; Single centre analysis; Third liver transplantation