Retransplantation of the liver—A seven-year experience

Anthony M. D’Alessandro, Rutger J. Ploeg, Stuart J. Knechtle, John D. Pirsch, Mark D. Stegall, Robert Hoffmann, Hans W. Sollinger, Folkert O. Belzer, Munci Kalayoglu

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104 Scopus citations

Abstract

Three hundred and four patients underwent 362 liver transplants between July 1984 and April 1992. Fifty-eight retransplants were performed in 44 patients (14.5%). Thirty-four patients underwent two (77.3%), seven patients three (15.9%), two patients four (4.5%), and one patient five (2.3%) transplants. Poor function accounted for 23 retransplants (6.4%), technical problems for 19 retransplants (5.2%), and rejection for 15 retransplants (4.1%). One-month patient survivals after retransplantation for poor function, technical problems, or rejection were similar (79.0%, 73.4%, and 80.0%, respectively). No difference in retransplantation rates were seen between adults and children receiving whole liver transplants (WLT) (11.6% versus 19.1%). However, retransplantation for poor function was more common in pediatric recipients receiving reduced-size liver transplants (RLT) (20.0% versus 0.0%, P<0.01), while retransplantation for hepatic artery thrombosis (HAT) was more common in pediatric recipients receiving WLT (16.7% versus 2.8%, P<0.05). The presence of multiorgan system failure of greater than four was associated with a high mortality (90%), whereas patients undergoing emergent retransplantation who had less than four systems fail had a survival of 73.9% and patients who underwent elective retransplantation had a survival rate of 81.8%. Length of stay and cost of liver transplantation was higher in patients undergoing retransplantation when compared with primary transplants (29.7±14.9 days versus 58.4±38.9 days and ±122,358± 59,782 versus ±289, 302±126, 907, P<0.01). The overall actuarial one-year patient survival in primary transplants was 86.6% and in retransplants 74.8%, and at five years these were 71.4% versus 62.5%, respectively (P<0.05). Our results support continued retransplantation of the liver unless the patient’s medical condition dictates otherwise.

Original languageEnglish (US)
Pages (from-to)1083-1086
Number of pages4
JournalTransplantation
Volume55
Issue number5
StatePublished - May 1993

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ASJC Scopus subject areas

  • Transplantation

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D’Alessandro, A. M., Ploeg, R. J., Knechtle, S. J., Pirsch, J. D., Stegall, M. D., Hoffmann, R., Sollinger, H. W., Belzer, F. O., & Kalayoglu, M. (1993). Retransplantation of the liver—A seven-year experience. Transplantation, 55(5), 1083-1086.