title: Irreversible Graft Failure Requiring 3 Repeated Liver Transplantations Combined With a 2-Stage Liver Transplantation: A Case Report.
abstract: BACKGROUND
  Although repeated liver transplantation (RLT) for irreversible graft failure is relatively rare, RLT is the only life-saving option available for a patient with failure of a previous liver transplant (LT). In cases in which failure of a previous LT is combined with TLS and exsanguination, waiting for organ allocation is not feasible and 2-stage liver transplantation (TSLT) is required. The aim of our case report was to describe the clinical management, including the criteria informing clinical decisions, for a patient who required 3 RLTs combined with TSLT.
  
  
  METHODS
  A 55-year-old man was admitted with liver cirrhosis associated with hepatitis B and multiple hepatocellular carcinomas. LT was performed using an emergent deceased donor graft of marginal quality. The graft was unsuccessful, with the patient showing hemodynamic deterioration and primary nonfunction of the graft. A total hepatectomy, with temporary portocaval shunt, was performed, with a second transplantation performed 3 days later. The second graft was from a 71-year-old, non-heart-beating donor, which resulted in a second episode of primary nonfunction. A third transplantation was performed 4 days later. The patient progressively recovered with extensive rehabilitation.
  
  
  CONCLUSIONS
  We report the successful outcome for a patient requiring 3 RLTs, with TSLT used as a bridge between transplants to reduce the duration of the anhepatic state. In selected cases, the combination of RLT and TSLT can provide a chance of survival from life-threatening liver failure.
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Y M
authors.initials: YM
authors.lastname: Park
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: K H
authors.initials: KH
authors.lastname: Yang
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: H Y
authors.initials: HY
authors.lastname: Lee
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: B H
authors.initials: BH
authors.lastname: Choi
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Ryu
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea. Electronic address: liversurgeon@hanmail.net.
authors.forename: C W
authors.initials: CW
authors.lastname: Chu
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications; D006084:Graft Rejection / Q000209:etiology / Q000601:surgery*; D006439:Hemodynamics; D006498:Hepatectomy / Q000379:methods*; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery*; D017093:Liver Failure / Q000209:etiology / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data