11th Congress of the Andalusian Society of Organ and Tissue Transplantation
Liver transplantation
Liver Retransplantation: The Changing Scenario in a Tertiary Medical Center

https://doi.org/10.1016/j.transproceed.2019.12.026Get rights and content

Abstract

Aim

To analyze the causes of liver retransplantation (LRT), which mostly depend on recipient factors.

Materials and Methods

A descriptive, observational, and unicentric study including patients who underwent an LRT in a tertiary medical center between April 2002 and December 2018. Recipient, donor, and liver transplant data were collected.

Results

During the period under review a total of 468 transplants were made; among them, 32 (6.8%) were LRT. The most common indication (25%) was hepatic artery thrombosis (HAT) developing ischemic cholangiopathy followed by chronic rejection (21.8%). Late LRT was performed in 71.8%. A total of 96.8% of donations were after brain death with a donor median age of 65 years. Six patients (18.7%) had HAT as a postoperative complication. The recipients’ 3-, 6-, and 12-month overall survival was 72.7%, 54.6%, and 51.5%, respectively, and the 5-year was 46.8%. Leading cause of death was septic shock (42.1%).

Conclusion

In our patients, the most common cause of LRT is HAT. We had an LRT rate of 6.8%, which is consistent with national and international registers.

Section snippets

Materials and Methods

We performed a single-center observational, retrospective study including patients who underwent LRT in a tertiary medical center between January 2002 and December 2018. LRTs were classified as early (within the first 6 months after primary transplant) or late (after 6 months). In terms of data analysis, qualitative variables are expressed as frequencies and absolute numbers, and quantitative variables as median and interquartile range. We collected recipient variables such as age, sex, body

Results

During the period under review a total of 468 transplants were made. Thirty-two of them (6.8%) underwent an LRT. Demographics and characteristics of patients are described in Table 1. The indications of LRT were: 8 HAT with ischemic cholangiopathy (IC) (25%), 7 CR (21.8%), 6 nonarterial IC (18.7%), 4 EGF (12.5%), 1 (3.1%) HCV reinfection, 1 (3.1%) portal thrombosis, and 5 nonregistered causes. The 35.2% of patients met Olthoff criteria and the median MEAF score was 4.46 (2.35-6.57). Vascular

Discussion

In this review of the practice of a low to medium volume LT unit, we have obtained an LRT rate of 6.8%, of which the most common indication was HAT with IC. The most frequent and severe postoperative morbidity made reference to vascular complications, mostly with the development of HAT.

In recent years, LT rate has showed a global rise, due to the increase of available grafts and some new indications under scrutiny. Because of that, LRT indications have became an issue of debate among experts.

Conclusion

A low to medium volume LT unit can obtain LRT rates aligned with current standards. In our experience, the most common cause of LRT was HAT causing IC, followed by CR. Because of that, a narrow and long-term follow-up and an early detection and treatment of these complications are mandatory.

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