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What is the prognosis after retransplantation of the liver?

Ali Zarrinpar1, Johnny C Hong

  • 1Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, 650 C. E. Young Drive South, 77-120 CHS, Box 957054, Los Angeles, CA 90095, USA.

Advances in Surgery
|August 10, 2012
PubMed

Insights

Hepatic retransplantation (ReLT) is ethically necessary for failing liver grafts, with excellent outcomes for low- and intermediate-risk patients. High-risk candidates should not undergo ReLT due to poor survival.

Area of Science:

  • Hepatology
  • Transplantation Surgery
  • Critical Care Medicine

Background:

  • Liver transplantation is a life-saving procedure, but graft failure necessitates retransplantation.
  • Ethical and practical considerations support the continuation of hepatic retransplantation (ReLT).
  • Risk stratification is crucial for selecting appropriate candidates for ReLT.

Purpose of the Study:

  • To evaluate the outcomes of hepatic retransplantation (ReLT) in patients with failing liver grafts.
  • To establish recommendations for risk stratification of retransplant candidates.
  • To define the criteria for pursuing or withholding ReLT.

Main Methods:

  • Review of existing literature and clinical guidelines on hepatic retransplantation.
  • Analysis of patient and graft survival data based on risk stratification categories.
  • Assessment of the technical demands and necessary support systems for ReLT.

Main Results:

  • Long-term patient and graft survival are excellent for low-risk and acceptable for intermediate-risk ReLT candidates.
  • Hepatic retransplantation is not recommended for high-risk candidates due to unfavorable outcomes.
  • ReLT is a technically complex procedure requiring specialized surgical, anesthesiology, and critical care expertise.

Conclusions:

  • Hepatic retransplantation remains a viable option for select patients with failing liver grafts.
  • A robust risk stratification strategy is essential for optimizing ReLT candidate selection.
  • Successful ReLT necessitates experienced multidisciplinary teams and comprehensive post-operative critical care support.

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