Liver Retransplantation Results And Risk Factors:a Single-center Experience

BackgroundIn the recent decades, liver transplantation has become the most effective and important way to manage end-stage liver diseases. The incidence of retransplantation, the only form of treatment for patients with irreversible graft failure, varies between5%and20%. Compared with the first liver transplant patients, liver retransplant patients have inferior outcomes, longer hospital stays and larger costs, and more importantly, utilize more than one donor liver. Therefore it is important to analyze the risk factors that lead to the death after retransplantation so as to guide the clinical judgment. This study aimed to retrospectively analyze mortality risk factors of liver retransplantation based on our single-center data.Methods31patients undergoing liver retransplantation in our transplant center between 2005.1and2012.12were retrospectively studied. The survival at30d,90d and1year was calculated. We then analyzed recipients’age, gender, the days between first and second transplantation, indication of retransplantation, prothrombin time, serum creatinine, bilirubin, white blood cell count, MELD score, blood loss during operation and ABO compatibility.ReslutsThe incidences of retransplantation included:biliary complication (n=15), primary graft failure (n=8), hepatic artery thrombosis (n=3), acute rejection (n=2), small-for-size syndrome (n=2), hepatic vein thrombosis (n=1). The retransplant patient survival at30d,90d and1year was74%,65%and55%respectively, compared to93%,90%and82%in a series of181first transplant patients (P<0.05). High MELD score was found to associate with worse outcomes (P<0.05). The1year survival of patients with MELD>20was only31.6%. The most common incidence is primary graft failure for early retransplantation and biliary complication for the late. The late retransplant patients usually had better prothrombin time and MELD scores, however more blood loss during operations. And the survival at30d,90d and1year were85%,77%and77%for the late retransplant patients, which seemed better than67%,56%and39%for the early. However there was no significant difference in survival between the early and late retransplant patients.ConclusionCompared with first liver transplant patients, retransplant patients have inferior outcomes. MELD score is effective to predict the outcome of retransplant patients. Patients with MELD score>20had inferior outcomes. Even early and late liver retransplantations had different indications and clinical manifestation, they had similar survival.