Trends and experiences in liver retransplantation over 15 years

Abstract

Compared to primary liver transplantation (LT), the inferior results in the outcome of liver retransplantation (re‐LT) continue to be a major challenge. The purpose of this study was to analyze changes in and outcomes of re‐LT over a period of 15 years at the Charité Virchow Clinic. Between 1989 and 2003, we performed 1,619 LTs and 157 re‐LTs (9.7%) in 1,462 patients. A total of 119 retransplants (50 females, 69 males) were analyzed after consideration of exclusion criteria: recipient age <16 years, second re‐LT, primary LT as split‐liver or living‐related LT, or combination with renal transplantation or Whipple operation. All patients received a whole‐size organ. Mean follow‐up was 62 months (6 days to 187 months). The main indications for re‐LT were initial nonfunction (26.9%), recurrence of viral‐induced hepatitis (20.2%), or acute and chronic rejection or thrombosis of the hepatic artery (both 16.8%). The main causes of death were bacterial infections (26.0%) as well as bleeding complications or recurrence of disease (both 16.0%) within the first postoperative month. Overall, 50 out of 119 patients (42%) died after re‐LT, 26 patients within the first 3 months and 38 within 1 year. Overall patient survival was 89.9% after 1 month, 78.2% after 1 year, and 67.1% after 5 years. In conclusion, our study showed good clinical results after re‐LT. Apart from the changing indications for re‐LT with an increasing amount of initial organ failure and hepatic artery thrombosis, the analysis also showed a decreasing amount of complications such as rejection, ischemic type biliary lesions, and recurrence of the disease with unchanged outcome over a period of 15 years. Liver Transpl, 2006. © 2006 AASLD.