Early liver retransplantation in adults

Rana, Abbas; Petrowsky, Henrik; Kaplan, Bruce; Jie, Tun; Porubsky, Marian; Habib, Shahid; Rilo, Horacio; Gruessner, Angelika C.; Gruessner, Rainer W.G.

doi:10.1111/tri.12201

Cited by 39 publications

(29 citation statements)

References 41 publications

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“…In accordance with their criteria, our data showed a similar incidence of EAD (24.3%) in transplant patients, although substantial risk factors appeared somewhat different, including donor age and MELD score in the study by Olthoff et al and intraoperative blood transfusion in our study. In the multivariate analysis, we included risk factors that had been reported as significant in prior studies, such as recipient and donor ages, macrovesicular steatosis, MELD score, and cold ischemic time, among others.…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of lactate clearance for the development of early allograft dysfunction and short‐term prognosis in deceased donor liver transplantation

Kim

Lee

Jung

et al. 2017

Clinical Transplantation

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This retrospective study evaluated lactate clearance (LC), measured at 6, 12, 18, and 24 hours after reperfusion, as a predictor of early allograft dysfunction (EAD) and short-term outcomes in patients receiving deceased donor liver transplantation. Of 181 transplant recipients, 44 (24.3%) developed EAD and had lower LCs than those who did not develop EAD. A receiver operating characteristic analysis showed that LC determined at 6 hours showed the highest area under curve value of 0.828 (95% confidence interval [CI]: 0.755-0.990) for predicting the development of EAD at a cutoff value of 25.8% with 76.7% sensitivity and 77.9% specificity. LC values that fell below the cutoff values were significantly associated with EAD in a multivariate analysis, with values at 6 hours having the highest adjusted odds ratio (11.891, 95% CI: 4.469-31.639). In-hospital and 6 month mortalities were higher in patients with LC values below the cutoffs compared with those above the cutoff values at each time point. Thus, LC calculated shortly after reperfusion of an allograft is significantly discriminative for the development of EAD and is associated with short-term prognosis after deceased donor liver transplantation.

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Section: Discussionmentioning

confidence: 99%

Clinical significance of lactate clearance for the development of early allograft dysfunction and short‐term prognosis in deceased donor liver transplantation

Kim

Lee

Jung

et al. 2017

Clinical Transplantation

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“…26,27 Conversely, according to UNOS records in 49 288 recipients from January 1, 2002 through October 31, 2011, the ReTx rate was 5.5% (n = 2714), with a 2.1% (n = 1056) rate of ReTx in the first monthafter transplant; the main reasons within the first month posttransplant were HAT and PNF. 28 The European Liver Transplant Registry (ELTR) reported a ReTx rate of 7% (n = 5596), according to records of 83 816 recipients from May 1968 through December 2009. The most common causes of ReTx in the ELTR group were vascular complications (27%) and PNF (25%).…”

Section: Discussionmentioning

confidence: 99%

Untitled

Yankol

Mecit²,

Kanmaz³

et al. 2016

Exp Clin Transplant

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Objectives: We present here the outcomes of our first 500 liver transplants and discuss the lessons learned during this time. The main cause of chronic liver failure was biliary atresia in pediatric patients (30.4%) and chronic hepatitis B infection in adults (35.6%). The complication rate for primary nonfunction was 3.8%, overall biliary complications 24.0% (significantly higher after adult living-donor liver transplant, 30.3%), hepatic artery thrombosis 1.6%, portal vein thrombosis 3.0%, retransplant 3.8%, acute cellular rejection 29.6%, and bacterial infection 39.4%. Overall 1-, 3-, and 5-year patient survival rates in the first 500 consecutive transplants performed on recipients within United Network for Organ Sharing listing criteria were 87.8%, 85.0%, and 78.6%; for hepatocellular carcinoma patients beyond the Milan criteria, survival rates were 71.9%, 52.5%, and 38.2%. Conclusions:In regions without a sufficient number of deceased donors, living-donor liver transplant, with its associated problems, is the only alternative to deceased-donor liver transplant. Liver transplant requires teamwork, with all players working well together for a successful outcome. The important keys to success in liver transplant include decision-making, timing, surgical skills, experience, and close follow-up.

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“…Third, survival rates after retransplantation have to be kept in mind. Recent data demonstrated significantly inferior survival rates for retransplantations in the first 7 days with 1‐year survival of approximately 65%.…”

Section: Discussionmentioning

confidence: 99%

MELD at POD 1 as a predictor of outcome in liver allografts with peak AST >5000 U/l

et al. 2014

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SummaryPerioperative liver graft injury is associated with elevation of aminotransferases after orthotopic liver transplantation (OLT). Values above 5000 U/l usually are regarded as extreme liver graft injury (ELGI). Some patients and organs recover from this critical condition. The aim of the study was to evaluate factors contributing to graft and patient survival after ELGI. From chart review we identified 64 of 917 OLT adult patients (median age 54.2 years; 68.8% males) transplanted between 11/2003 and 02/2012, who presented ELGI after OLT. Donor and recipient factors were analyzed and correlated with the outcome by univariable and multivariable methods. Multivariable cox proportional hazards showed that recipient's BMI (P = 0.01), model for end stage liver disease (MELD) score before OLT (P = 0.02) and laboratory MELD score 24 h after OLT (P = 0.01) were independently associated with patient survival. 30-days and 12-months survival in patients with a postoperative laboratory MELD higher than 31 was 21.4%, while patients with a postoperative laboratory MELD lower than 31 displayed 30-days and 12-months survival rates of 80% and 71.8%, respectively (P < 0.001). Retransplantation in the setting of ELGI after OLT should be based on all available data. Utilization of the postoperative labMELD enables the transplant physician within 24 h after transplantation to identify necessity of retransplantation objectively.

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Early liver retransplantation in adults

Cited by 39 publications

References 41 publications

Clinical significance of lactate clearance for the development of early allograft dysfunction and short‐term prognosis in deceased donor liver transplantation

Clinical significance of lactate clearance for the development of early allograft dysfunction and short‐term prognosis in deceased donor liver transplantation

Untitled

MELD at POD 1 as a predictor of outcome in liver allografts with peak AST >5000 U/l

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