Transplantation 1993 May;55(5):1083-7

Retransplantation of the liver--a seven-year experience

D'Alessandro AM, Ploeg RJ, Knechtle SJ, Pirsch JD, Stegall MD, Hoffmann R,
Sollinger HW, Belzer FO, Kalayoglu M

Department of Surgery, University of Wisconsin Medical School, Madison 53792

Abstract

Three hundred and four patients underwent 362 liver transplants between July
1984 and April 1992. Fifty-eight retransplants were performed in 44 patients
(14.5%). Thirty-four patients underwent two (77.3%), seven patients three
(15.9%), two patients four (4.5%), and one patient five (2.3%) transplants. Poor
function accounted for 23 retransplants (6.4%), technical problems for 19
retransplants (5.2%), and rejection for 15 retransplants (4.1%). One-month
patient survivals after retransplantation for poor function, technical problems,
or rejection were similar (79.0%, 73.4%, and 80.0%, respectively). No difference
in retransplantation rates were seen between adults and children receiving whole
liver transplants (WLT) (11.6% versus 19.1%). However, retransplantation for
poor function was more common in pediatric recipients receiving reduced-size
liver transplants (RLT) (20.0% versus 0.0%, P < 0.01), while retransplantation
for hepatic artery thrombosis (HAT) was more common in pediatric recipients
receiving WLT (16.7% versus 2.8%, P < 0.05). The presence of multiorgan system
failure of greater than four was associated with a high mortality (90%), whereas
patients undergoing emergent retransplantation who had less than four systems
fail had a survival of 73.9% and patients who underwent elective
retransplantation had a survival rate of 81.8%. Length of stay and cost of liver
transplantation was higher in patients undergoing retransplantation when
compared with primary transplants (29.7 +/- 14.9 days versus 58.4 +/- 38.9 days
and $122,358 +/- 59,782 versus $289,302 +/- 126,907, P < 0.01). The overall
actuarial one-year patient survival in primary transplants was 86.6% and in
retransplants 74.8%, and at five years these were 71.4% versus 62.5%,
respectively (P < 0.05). Our results support continued retransplantation of the
liver unless the patient's medical condition dictates otherwise