Morbidity and mortality in liver retransplantation

Area of Science:

• Hepatology
• Transplantation Surgery
• Clinical Outcomes Research

Background:

• Orthotopic liver retransplantation (re-OLT) occurs in 6-11% of liver transplants.
• Common causes include allograft failure, acute rejection, and vascular issues.

Purpose of the Study:

• To analyze the incidence, indications, complications, and outcomes of re-OLT.
• To compare re-OLT patients with primary orthotopic liver transplant (OLT) recipients.

Main Methods:

• Retrospective analysis of 512 OLTs in 482 patients over 15 years.
• Data collected on re-OLT incidence, reasons for re-OLT, complications, and survival.

Main Results:

• Re-OLT incidence was 6.6%, with men more frequently requiring it.
• Indications included thrombosis (21.7%), primary nonfunction (PNF, 21.7%), and chronic rejection (40.4%).
• Higher rates of PNF, acute renal failure, infection, and ARDS in re-OLT; survival was significantly lower (21.8 vs 194.5 days).
• Mortality varied by indication: 100% for primary biliary cirrhosis, 85.7% for HCV.
• Model for End-stage Liver Disease (MELD) score correlated with complications.

Conclusions:

• Men and patients with HBV cirrhosis or fulminant hepatitis showed higher re-OLT rates.
• Re-OLT patients had increased primary graft dysfunction, renal failure, ARDS, and infection, but not sepsis.
• MELD score effectively predicted graft outcomes.
• Re-OLT for primary biliary cirrhosis and HCV is associated with high mortality.