Impact of Altered Graft Position During Living Donor Liver Retransplantation and its Outcomes

Liver retransplantation (reLT), which is the only treatment for liver graft failure, remains challenging not only because of its technical nature but also because it is performed in high-risk patients.

Nineteen patients who underwent reLT (second LT, n = 18; third LT, n = 1) between 1999 and 2021 were divided into two groups according to the graft laterality between prior transplantation and reLT (ipsilateral group, n = 9; contralateral group, n = 10). The aim of this study was to evaluate the short- and the long-term outcomes of patients who underwent living donor reLT and compared graft survival between ipsilateral and contralateral grafts.

For hepatic vein reconstruction, the previous anastomotic orifice of the recipient was used in 8 (88.9%) patients in the ipsilateral group, while a new orifice on inferior vena cava of the recipient was created in 8 (80%) patients in the contralateral group. The conduit for the portal vein and hepatic artery were employed in 2 and 2 patients in the ipsilateral group and in 5 and 0 patients in the contralateral group, respectively. The overall incidence of hepatic artery and portal vein complications was 11.1% and 11.1% in the ipsilateral group, and 30% and 11.1% in the contralateral group, respectively. The 1-, 5-year graft survival rates were 70.8%, 66.7% in the ipsilateral group, and 70%, 70% in the contralateral group, respectively.

There was no difference between ipsilateral and contralateral grafts in reLT in terms of surgical complications and graft survival.