[Liver retransplantation: outcome analysis in 50 patients]

Liver re-transplantation (re-LT) is an accepted indication for some (technical problems, primary non-function [PNF]) but not all indications, particularly recurrence of the original disease, such as hepatitis C. We aimed to determine in our center: a) the rate of survival following re-transplantation for all and each different indication; b) to compare it to that obtained by a control group; c) to assess whether late re-LT, excluding PNF and surgical problems, and re-LT in HCV (+) patients are associated with a higher mortality, and d) to estimate medical costs.

Form 1991 to April 2002, 50 re-LT were done (group 1). Group 2 consisted of 45 primary LT controlled by transplant date. Group 1 was divided in two subgroups: a) re-LT after 6 months of the first LT (recurrence of primary liver disease n = 20, chronic rejection n = 5), b) Re-LT in the first 6 months (PNF n = 13, artery thrombosis n = 12). We analyzed donor, recipient, surgical and immunosuppressive-related variables.

The mean age was 50 years (range: 23-63) (72% men). Actuarial survival for re-LT was lower than for the control group: 64%, 57% and 50% vs 84%, 82% and 82% at 1st, 3rd and 5th year, respectively. By indication, the 3-year survival was: PNF: 61% (p = 0.05), HAT: 58% (p = 0.02), recurrence of primary disease: 52% (p = 0.001), chronic rejection: 60% (p = 0.346). Although not reaching statistical significance, survival was lower in late vs early re-LT (p = 0.16) and in HCV-infected versus non-infected patients (p = 0.08). In the HCV (+) group, there were no differences by re-transplant indication (p = 0.8). Medical costs and complications were substantially higher in group 1 vs group 2.

Re-LT is associated with substantial medical costs and mortality, particularly in patients infected with HCV.