Indications for and Survival After Liver Retransplantation

Bellido, C. Bernal; Martínez, J. M. Álamo; Gómez, Luis Miguel Marín; Artacho, G. Suárez; Díez-Canedo, J. Serrano; Barrera-Pulido, L.; Acevedo, Juan Manuel Pascasio; Bravo, Miguel Ángel Gómez

doi:10.1016/j.transproceed.2010.02.017

Cited by 29 publications

(16 citation statements)

References 15 publications

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“…Even though HA ligation was usually followed by ischemic cholangiopathy requiring retransplantation, this multimodal management postponed the time of retransplantation, which was performed electively rather than urgently in three patients. Although elective retransplantation had poor results in the present series, it has recently been reemphasized that elective retransplantation was associated with better survival than urgent retransplantation, which was statistically significant . Therefore, putting off the time of retransplantation after resolution of hemorrhage and sepsis might result in better overall outcomes in patients with better general and nutritional status.…”

Section: Discussionmentioning

confidence: 62%

Hepatic Artery Ligation for Arterial Rupture Following Liver Transplantation: A Reasonable Option

Boleslawski

Bouras

Truant

et al. 2013

American Journal of Transplantation

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Hepatic artery (HA) rupture after liver transplantation is a rare complication with high mortality. This study aimed to review the different managements of HA rupture and their results. From 1997 to 2007, data from six transplant centers were reviewed. Of 2649 recipients, 17 (0.64%) presented with HA rupture 29 days (2-92) after transplantation. Initial management was HA ligation in 10 patients, reanastomosis in three, aorto-hepatic grafting in two and percutaneous arterial embolization in one. One patient died before any treatment could be initiated. Concomitant biliary leak was present in seven patients and could be subsequently treated by percutaneous and/or endoscopic approaches in four patients. Early mortality was not observed in patients with HA ligation and occurred in 83% of patients receiving any other treatment. After a median follow-up of 70 months, 10 patients died (4 after retransplantation), and 7 patients were alive without retransplantation (including 6 with HA ligation). HA ligation was associated with better 3-year survival (80% vs. 14%; p = 0.002). Despite its potential consequences on the biliary tract, HA ligation should be considered as a reasonable option in the initial management for HA rupture after liver transplantation.Unexpectedly, retransplantation was not always necessary after HA ligation in this series.

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Section: Discussionmentioning

confidence: 62%

Hepatic Artery Ligation for Arterial Rupture Following Liver Transplantation: A Reasonable Option

Boleslawski

Bouras

Truant

et al. 2013

American Journal of Transplantation

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“…The ultimate therapeutic choice is liver retransplantation [4,10]. The palliative treatment of symptoms may be conservative, consisting management of itching, fluid intake, or minimally invasive procedures.…”

Section: Discussionmentioning

confidence: 99%

“…In anastomotic strictures, good results are achieved with surgery or minimally invasive therapy [2,3]. Intrahepatic stenosis usually requires retransplantation; however, survival chances are less favorable [4]. For palliation and bridging to retransplantation, percutaneous and endoscopic interventions are used [5].…”

Section: Introductionmentioning

confidence: 99%

Non-anastomotic biliary strictures after liver transplantation: Focus on percutaneous treatment and extent of disease

Doros

Deák

Hartmann

et al. 2012

IMAS

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Abstract:Introduction: Biliary strictures remain a key problem after liver transplantation. Anastomotic strictures are treated by surgery or interventional therapy. Intrahepatic stenosis requires retransplantation. For bridging, percutaneous and endoscopic interventions are used. The extent of the strictures may have an important role in therapy planning. Methods: Strictures were divided into four zones (1: extrahepatic, not included in this study; 2: hilar; 3: central; 4: peripheral). Twenty patients were treated with balloon dilatation/stent implantation/ retransplantation/supportive care (Zone 1: 0/0/0/0; Zone 2: 8/7/2/0; Zone 3: 7/5/2/1; Zone 4: 1/1/3/1). Results: Mean follow-up time was 48 months. In Zone 2, one patient died as a result of recurrent hepatocellular carcinoma (HCC), and seven patients are alive, five after stent placements and two after retransplantation. Four patients are alive in Zone 3: all had stent placements and one later retransplantation. One patient died after retransplantation, two on the waiting list, and one due to chronic liver failure. One patient is alive in Zone 4 after early retransplantation, and three died. Conclusion: Percutaneous therapy is safe and effective in intrahepatic biliary stenosis after liver transplantation. It can provide the cure or bridge retransplantation. Based on zonal classification, we recommend the following treatments: Zone 4: early retransplantation; Zone 2: minimally invasive therapy; Zone 3: individual decisions.

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“…Challenge of retransplantation : Overall, retransplantation for HCV‐associated graft failure is associated with a worse prognosis than primary transplantation for HCV. The role of retransplantation for patients who develop graft failure from recurrent HCV is controversial since retransplantation for recurrent HCV is associated with a worse prognosis than other indications for retransplantation (71). Indeed, retransplantation for recurrent HCV disease may carry up to a 30% increased mortality risk.…”

mentioning

confidence: 99%

Major Challenges Limiting Liver Transplantation in the United States

Wertheim

Petrowsky

Saab

et al. 2011

American Journal of Transplantation

161

117

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Liver transplantation is the gold standard of care in patients with end-stage liver disease and those with tumors of hepatic origin in the setting of liver dysfunction. From 1988 to 2009, liver transplantation in the United States grew 3.7-fold from 1713 to 6320 transplants annually. The expansion of liver transplantation is chiefly driven by scientific breakthroughs that have extended patient and graft survival well beyond those expected 50 years ago. The success of liver transplantation is now its primary obstacle, as the pool of donor livers fails to keep pace with the growing number of patients added to the national liver transplant waiting list. This review focuses on three major challenges facing liver transplantation in the United States and discusses new areas of investigation that address each issue: 1) the need for an expanded number of useable donor organs, 2) the need for improved therapies to treat recurrent hepatitis C after transplantation and 3) the need for improved detection, risk stratification based upon tumor biology and molecular inhibitors to combat hepatocellular carcinoma.

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Indications for and Survival After Liver Retransplantation

Cited by 29 publications

References 15 publications

Hepatic Artery Ligation for Arterial Rupture Following Liver Transplantation: A Reasonable Option

Hepatic Artery Ligation for Arterial Rupture Following Liver Transplantation: A Reasonable Option

Non-anastomotic biliary strictures after liver transplantation: Focus on percutaneous treatment and extent of disease

Major Challenges Limiting Liver Transplantation in the United States

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