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 Ͻ16 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 13: [248][249][250][251][252][253][254][255][256][257] 2007 See Editorial on Page 188Over the last 2 decades, liver transplantation (LT) has developed into a successful standard surgical therapy for terminal liver failure, 1-3 showing 1-year survival rates of over 80% and 5-year survival rates of over 70% in experienced centers. [4][5][6][7] Despite this success, liver retransplantation (re-LT) shows significantly inferior results, 3,6,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] and for the majority of patients, re-LT remains the only alternative to death. The main reasons for poor outcome after re-LT are infections during the early postoperative period with septic complications, multiorgan failure, 3,12,13,[17][18][19]23,24 and bleeding complications, 3,13,16,17,19 and during the late course, predominant factors are recurrence of the disease and chronic rejection. 3,7,8,11,16 On the one hand, because more than 50% of deaths after re-LT occur within the first 3 months, 3,8,9,12 it is important to evaluate prognostic factors and therapeutic strategies to influence outcome during this period. [24][25][26][27][28][29] On the other hand, considering that the broader application of LT 3,5,6 and recurrence of disease result in increased numbers of patients awaiting re-LT, it becomes, in view of increasing donor organ shortages,...

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In dieser Rubrik stellen wir Ihnen interessante Neuerscheinungen vor ? aus unterschiedlichen Fachgebieten, aber immer relevant f?r die Weiterbildung. In dieser Ausgabe: