Retransplantation of the liver

Since the introduction of cyclosporine-prednisone for primary immunosuppression, retransplantation has become a feasible option for patients whose primary grafts are failing, which may result from primary graft nonfunction, intractable rejection, or consequent to technical complications. Although survival of patients requiring second grafts is less good than in those whose initial graft functions well, 2-year survival rates of 49% have been achieved in retransplanted patients, a record that mandates serious consideration of this approach when the primary graft begins to fail. In general, the retransplant procedure is technically easier, with less blood loss, than is the initial operation. When the reoperation is done electively, it should be done before serious clinical deterioration compromises the chances for success.