Liver retransplantation in adult recipients: analysis of a 38‐year experience in the Netherlands. (7th January 2020)

• Record Type: Journal Article
• Authors: Takagi, Kosei; Domagala, Piotr; Porte, Robert J.; Alwayn, Ian; Metselaar, Herold J.; van den Berg, Aad P.; van Hoek, Bart; Ijzermans, Jan N. M.; Polak, Wojciech G.
• Is Part Of: Journal of hepato-biliary-pancreatic sciences. Volume 27:Number 1(2020)
• Page Start: 26
• Page End: 33
• Publication Date: 2020-01-07
• Subjects: Liver retransplantation -- Outcome; Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 617.556
• DOI: 10.1002/jhbp.701
• Languages: English
• ISSNs: 1868-6974

Abstract

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. Abstract : Takagi and colleagues investigated liver retransplantation incidence, long‐term outcomes, and risk factors in the Netherlands. Retransplantation rates have increased, but clinical outcomes are good after multiple retransplantations. Recipient age 60 years, early transplantation era, post‐circulatory‐death donor, and increased cold ischemia time were risk factors for retransplantation.