Astrid Schielke1, Olivier Scatton2, Pierre-Yves Boelle3, Fabiano Perdigao1, Denis Bernard4, Olivier Soubrane5, Filomena Conti6. 1. Service de chirurgie digestive et transplantation hépatique, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France. 2. Service de chirurgie digestive et transplantation hépatique, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne Universités, UPMC université Paris 06, 4, place Jussieu, 75005 Paris, France. Electronic address: olivier.scatton@aphp.fr. 3. Sorbonne Universités, UPMC université Paris 06, 4, place Jussieu, 75005 Paris, France; Department of Public Health, Hôpital Saint-Antoine, AP-HP, 184, rue du faubourg Saint-Antoine, 75012 Paris, France. 4. Department of Anesthesiology, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France. 5. Service de chirurgie digestive et transplantation hépatique, hôpital Beaujon, AP-HP, 100, boulevard du Général Leclerc, 92110 Clichy, France; Université Paris 07, 5, rue Thomas-Mann, 75013 Paris, France. 6. Sorbonne Universités, UPMC université Paris 06, 4, place Jussieu, 75005 Paris, France; Unité de transplantation hépatique, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Abstract
BACKGROUND: Liver retransplantation (RLT) is the only life-saving treatment option for patients with a failing graft, but it remains a major challenge because of inferior outcomes and technical difficulties. METHODS: This study aimed to evaluate the outcomes of and risk factors for adult RLT in a single center, focusing on the etiology of graft failure. Between 1987 and 2011, 1592 liver transplants (LTs) and 143 RLTs (9%) were performed at our institution. RESULTS: The 1-, 5- and 10-year patient survival rates after RLT were 60%, 52% and 39%, and the graft survival rates were 55%, 46% and 32%. The 90-day mortality rate was 32%, mainly due to septic complications (45% of deaths). Ischemic-type biliary lesions (ITBL) were the leading indication for RLT (23%), and patient survival was significantly better in patients retransplanted for ITBL than for any other indication (P<0.02). Indications other than ITBL (P=0.015), the transfusion of more than 7 units (P=0.006) and preoperative dialysis (P=0.005) were the three parameters associated with poor survival after RLT. CONCLUSION: Patients with ITBL benefit the most from elective RLT.
BACKGROUND: Liver retransplantation (RLT) is the only life-saving treatment option for patients with a failing graft, but it remains a major challenge because of inferior outcomes and technical difficulties. METHODS: This study aimed to evaluate the outcomes of and risk factors for adult RLT in a single center, focusing on the etiology of graft failure. Between 1987 and 2011, 1592 liver transplants (LTs) and 143 RLTs (9%) were performed at our institution. RESULTS: The 1-, 5- and 10-year patient survival rates after RLT were 60%, 52% and 39%, and the graft survival rates were 55%, 46% and 32%. The 90-day mortality rate was 32%, mainly due to septic complications (45% of deaths). Ischemic-type biliary lesions (ITBL) were the leading indication for RLT (23%), and patient survival was significantly better in patients retransplanted for ITBL than for any other indication (P<0.02). Indications other than ITBL (P=0.015), the transfusion of more than 7 units (P=0.006) and preoperative dialysis (P=0.005) were the three parameters associated with poor survival after RLT. CONCLUSION:Patients with ITBL benefit the most from elective RLT.