Pediatric Liver Retransplantation: Indications and Outcome

Uribe, Mario; Buckel, E.; Ferrario, M.; Hunter, B.; Godoy, J.; González, G.; Cavallieri, S.; Íñiguez, R.; Calabrán, L.; Herzog, C.

doi:10.1016/j.transproceed.2006.12.031

Cited by 19 publications

(21 citation statements)

References 11 publications

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“…Previous single center and multicenter studies have revealed patient survival at one yr after retransplantation from 47% to 82%. This is decidedly inferior to that reported for primary LT (1–14). Owing to the scarcity of donor organs, hepatic retransplantation especially in pediatrics has generated significant ethical discussion regarding maximization of hepatic donor utilization.…”

contrasting

confidence: 62%

Liver retransplantation in children: The Atlanta experience

Heffron

Pillen

Smallwood

et al. 2010

Pediatric Transplantation

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Liver retransplantation is routinely offered at our institution. Previous reports document that patient and graft survival is significantly less after pediatric rLT compared to primary LT. This has engendered intense debate regarding optimal allocation of organs. Here, we examine our program's approach to pediatric hepatic retransplantation related to patient factors affecting outcomes. Between 1997 and 2009, 272 LTs were performed in 234 patients (mean survival 1994 +/- 1367 days) at our center. Thirty-four patients required rLT including 10 who received their primary transplant elsewhere and four who required two retransplantations. Patient survival did not differ significantly between rLT and LT at one and three yr (p = 0.56). Graft survival between rLT and LT was also similar (p = 0.606) at one and three yr. No significant difference in graft or patient survival was noted between: Patients retransplanted <30 days after LT vs. those >30 days (p = 0.152); patients transplanted with technical variants vs. whole grafts (p = 0.966); technical variants utilized for LT vs. rLT (p = 0.713); rLT recipient age (< or >5 yr; p = 0.298); or ABOI for rLT and LT (p = 0.650). Retransplantation should be offered to optimize pediatric recipient survival after LT and offers similar survival as primary transplant.

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contrasting

confidence: 62%

Liver retransplantation in children: The Atlanta experience

Heffron

Pillen

Smallwood

et al. 2010

Pediatric Transplantation

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“…1-3 Therefore, appropriate patient selection and time to transplant are important factors when deciding to perform a second or third liver transplant. Because liver retransplant results are statistically worse than results for a primary liver transplant, [3][4][5][6][7] decisions have to be made with the understanding that success in this procedure is never a guarantee.…”

Section: Discussionmentioning

confidence: 99%

“…Influenced by experience coming from other centers, we postponed the liver retransplant by nearly half a year so as to achieve a better outcome. 4,8,10,14,15 Liver retransplant is associated with dense adhesions, altered anatomy, and difficulties in identification of vascular structures. Mass clamping of the HDL can shorten graftectomy.…”

Section: Discussionmentioning

confidence: 99%

Successful Hepatoatrial Anastomosis During a Consecutive Liver Retransplant in the Same Patient Shows Good Long-Term Results: Case Report and 2-Year Follow-Up

Kobryń

Nyckowski²,

Milkiewicz³

et al. 2019

Exp Clin Transplant

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Liver retransplant is the last and only treatment for patients with irreversible graft failure. It is recognized as a high-risk procedure; thus surgical difficulties are multiplied with every successive liver transplant. Liver retransplant is a demanding technical procedure for the surgeon, with no guarantee of postoperative and long-term survival. Here, we report a 29-year-old male patient who underwent a liver transplant in April 2009 due to primary sclerosing cholangitis with overlapping autoimmune hepatitis. The patient underwent liver retransplant in May 2012 due to graft failure. A second liver retransplant was performed in April 2013 using the classical technique. An inflammatory process involving the inferior vena cava and diaphragm forced the surgeon to open the pericardium from the diaphragm and clamp the cuff of the right atrium to perform a hepatoatrial anastomosis of the inferior vena cava. The next steps were performed as for a typical liver transplant. Postoperative stay was free of complications and was not prolonged. Immunosuppression regimen was kept standard. During our follow-up of more than 32 months, the patient continued to show good results. A consecutive hepatectomy in the same recipient is associated with an increased risk of intraoperative complications. When excessive adhesions limit a safe and functioning cavocaval anastomosis, a hepatectomy with the excision of the intrahepatic inferior vena cava and endto-end anastomosis through a pericardial window for the extension of the recipient's' vena cava cuff are feasible options. We found that a hepatoatrial anastomosis does not impair good overall outcomes and long-term results.

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“…In the absence of effective methods of extracorporeal support, liver retransplantation (re‐LT) is necessary for lifesaving purposes and the only therapeutic option for survival when a transplanted liver graft fails, regardless of the cause. Up to 29% of all children that receive an LT eventually need to undergo re‐LT (1–10). However, the outcome of re‐LT for pediatric patients is worse than for the first LT (1–10).…”

mentioning

confidence: 99%

“…Up to 29% of all children that receive an LT eventually need to undergo re‐LT (1–10). However, the outcome of re‐LT for pediatric patients is worse than for the first LT (1–10). There are also various technical difficulties in total hepatectomy for failed liver graft and in the implantation of the liver graft to pediatric recipients (10).…”

mentioning

confidence: 99%

Pediatric liver retransplantation from living donors can be considered as a therapeutic option for patients with irreversible living donor graft failure

Urahashi

Mizuta

Sanada

et al. 2011

Pediatric Transplantation

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Liver retransplantation (re-LT) is required in patients with irreversible graft failure, but it is a significant issue that remains medically, ethically, and economically controversial, especially in living donor liver transplantation (LDLT). The aim of this study was to evaluate the outcome, morbidity, mortality, safety and prognostic factors to improve the outcome of pediatric living donor liver retransplantation (re-LDLT). Six of 172 children that underwent LDLT between January 2001 and March 2010 received a re-LDLT and one received a second re-LDLT. The overall re-LDLT rate was 3.5%. All candidates had re-LDLT after the initial LDLT. The overall actuarial survival of these patients was 83.3% and 83.3% at one and five yr, respectively. These rates are significantly worse than the rates of pediatric first LDLT. Vascular complications occurred in four patients and were successfully treated by interventional radiologic therapy. There were no post-operative biliary complications. One case expired because of hemophagocytic syndrome after re-LDLT. Although pediatric re-LDLT is medically, ethically, and economically controversial, it is a feasible option and should be offered to children with irreversible graft failure. Further investigations, including multicenter studies, are therefore essential to identify any prognostic factors that may improve the present poor outcome after re-LDLT.

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Pediatric Liver Retransplantation: Indications and Outcome

Cited by 19 publications

References 11 publications

Liver retransplantation in children: The Atlanta experience

Liver retransplantation in children: The Atlanta experience

Successful Hepatoatrial Anastomosis During a Consecutive Liver Retransplant in the Same Patient Shows Good Long-Term Results: Case Report and 2-Year Follow-Up

Pediatric liver retransplantation from living donors can be considered as a therapeutic option for patients with irreversible living donor graft failure

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