Kosei Takagi1, Piotr Domagala1, Robert J Porte2, Ian Alwayn3, Herold J Metselaar4, Aad P van den Berg5, Bart van Hoek6, Jan N M Ijzermans1, Wojciech G Polak1. 1. Division of HPB & Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. 2. Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands. 3. Department of Surgery, Transplant Center, Leiden University Medical Center, Leiden, The Netherlands. 4. Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands. 5. Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands. 6. Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
Abstract
BACKGROUND: Liver retransplantation (re-LT) accounts for up to 22% after primary liver transplantation (LT), and using donor livers for retransplantation can only be justified by successful outcomes. METHODS: A total of 2,387 adult recipients with 2,778 LT, between 1979 and 2017, were analyzed to determine risk factors and outcome of re-LT in the Netherlands. RESULTS: Of 2,778 LT, 336 (12.1%) were first, 43 (1.5%) were second, and 12 (0.5%) were third or fourth re-LT. The 5-year patient survival for primary LT, and first, second, and third or fourth re-LT were 74.0%, 70.8%, 63.3%, and 57.1%, respectively (P = 0.10). Recipient age (≤60 years) (OR 1.96, P < 0.001), era (1979-2006) (OR 1.56, P = 0.003), donor after circulatory death (DCD) (OR 1.96, P < 0.001), and cold ischemia time (CIT) (>9 h) (OR 1.42, P = 0.007) were significant risk factors for retransplantation after primary LT. CONCLUSIONS: Recipient age, era, DCD, and prolonged CIT were identified as parameters for retransplantation. The outcome after the first re-LT was good, and comparable to those of primary transplants. Survival after multiple re-LT was not significantly different from the first retransplant group, legitimizing third and fourth re-LT to well-selected patients.
BACKGROUND: Liver retransplantation (re-LT) accounts for up to 22% after primary liver transplantation (LT), and using donor livers for retransplantation can only be justified by successful outcomes. METHODS: A total of 2,387 adult recipients with 2,778 LT, between 1979 and 2017, were analyzed to determine risk factors and outcome of re-LT in the Netherlands. RESULTS: Of 2,778 LT, 336 (12.1%) were first, 43 (1.5%) were second, and 12 (0.5%) were third or fourth re-LT. The 5-year patient survival for primary LT, and first, second, and third or fourth re-LT were 74.0%, 70.8%, 63.3%, and 57.1%, respectively (P = 0.10). Recipient age (≤60 years) (OR 1.96, P < 0.001), era (1979-2006) (OR 1.56, P = 0.003), donor after circulatory death (DCD) (OR 1.96, P < 0.001), and cold ischemia time (CIT) (>9 h) (OR 1.42, P = 0.007) were significant risk factors for retransplantation after primary LT. CONCLUSIONS: Recipient age, era, DCD, and prolonged CIT were identified as parameters for retransplantation. The outcome after the first re-LT was good, and comparable to those of primary transplants. Survival after multiple re-LT was not significantly different from the first retransplant group, legitimizing third and fourth re-LT to well-selected patients.
Authors: Thomas G Cotter; Matthew A Odenwald; Sarah R Lieber; Nicole E Rich; Gene Im; Michael Charlton; Amit G Singal; Mack C Mitchell Journal: Transplant Direct Date: 2022-02-11
Authors: Marjolein van Reeven; Otto B van Leeuwen; Danny van der Helm; Sarwa Darwish Murad; Aad P van den Berg; Bart van Hoek; Ian P J Alwayn; Wojciech G Polak; Robert J Porte Journal: Transpl Int Date: 2020-03-09 Impact factor: 3.782