[Indications and results of liver retransplantations]

Liver retransplantation (re-LT) is the only therapeutic option for irreversible failure of the graft. It currently makes up 2.9% to 24.0% of all liver transplants. It is technically very difficult and has a high index of immediate complications, underlined by the fact that 50% of the deaths after this procedure occur in the first three months; and that in general, the results of re-LT are worse than those of primary LT. Re-LT can be early (when it is performed during the first 30 days) or delayed. The reasons for early re-LT are: loss of primary function of the graft, complications for technical reasons, acute resistant rejection and infection problems of biliary origin. Those of delayed are: chronic rejection, liver arterial thrombosis, biliary complications and recurrence of the primary disease. In general, when a patient has an irreversible rejection of the graft, the indication for a re-LT is indisputable, but there are discrepancies on whether or not the aetiology of the basic disease has to have a bearing on this. If we take into account the MELD scoring system, when considering the indications for re-LT, this only allows us to predict mortality, but not to give priority on a waiting list. Patients must be retransplanted early, in good physical condition, with a low bilirubin and creatine level; and the donors must be young. Taking into account the continuing increase in mortality as a direct result of the imbalance between the growing number of potential candidates and the number of donors, it seems necessary to define what are the minimally accepted results to indicate a re-LT and thus arrive at a consensus that will help us decide which subject is a candidate to receive it.