Retransplantation of the Liver: Review of Current Literature for Decision Making and Technical Considerations

Yoo, Peter S.; Umman, Veysel; Rodríguez-Dávalos, Manuel I.; Emre, Sükrü

doi:10.1016/j.transproceed.2013.02.063

Cited by 47 publications

(41 citation statements)

References 32 publications

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“…There have been several publications addressing the activities of organ donation and transplant in this region. [1][2][3] There have been several recent resolutions of the World Health Organization and transplant community that affected organ transplant around the world and in the Middle East. The resolutions included combating transplant tourism (Declaration of Istanbul) and calling on members of the World Health Organization to adopt the principle of selfsufficiency of organ donation and transplant, including preventive measures for diseases that may cause organ failure.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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The Middle Eastern map includes all the Arab countries, Iran, Turkey, Pakistan, and countries of Central Asia. There are common features of organ transplant in these countries such as inadequate preventive medicine, uneven health infrastructure, poor awareness of the medical community and public about the importance of organ donation and transplant, high level of ethnicity, poor government support of organ transplant, and political unrest. In addition, there is inadequate team spirit among transplant physicians, lack of planning for organ procurement and transplant centers, and lack of effective health insurance. Living-donor organ transplant is the most widely practiced type of transplant in the Middle East. Deceased-donor organ donation is not used properly because of continued debate in the medical community about the concept of death according to neurologic criteria (brain death) and inadequate awareness of the public about the importance of organ donation and transplant in many countries in this region. Continuous work is needed to provide solutions to overcome the current obstacles.

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Section: Introductionmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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“…Early complications account for half of all patients who need a reLTx. 19 Primary nonfunction is the cause in about 20% to 30% of all cases of reLTx, while vascular reasons, such as hepatic artery thrombosis (HAT) account for 15% to 31% 4,20 ; therefore, HAT and primary nonfunction account for nearly all cases of early reLTx (Table 2). 6,21,22 Compared with published data, the proportion of reLTx performed in our center for primary nonfunction was lower (10.7% of patients), this might be because of strict graft selection, procurement, and graft preservation protocols.…”

Section: Introductionmentioning

confidence: 99%

“…Hepatic artery thrombosis and subsequent ischemic cholangiopathy most often start in the early posttransplant period, but can be seen later (Table 2). 19,22 Whether the timing of reLTx is correlated to outcome, and whether the risk of death after early reLTx because of initial graft failure are different from that of late reLTx because of disease recurrence, has been addressed by several authors. 5,6,8,21 Busuttil and associates, 24 reviewed 3200 liver transplants at the University of California, Los Angeles, and concluded that among 13 donor and recipient variables, that 25 The mechanism underlying the lower survival rate associated with reLTx remains to be defined, although multiorgan dysfunction associated with failing grafts appears to contribute to the high perioperative mortality.…”

Section: Introductionmentioning

confidence: 99%

“…The presence of vascular collaterals due to portal hypertension or late hepatic artery thrombosis may further complicate operative procedure. 18,19 Survival models for liver retransplant Although some donor and perioperative factors have previously been reported to predict poor organ prognosis after reLTx, 5,9,11,16,17,26 these data are less applicable when a patient is listed for reLTx; therefore, prognostic factors related to the recipient seem to be more practical when the decision to offer reLTx is made. Several authors have attempted to devise risk scores to predict survival after reLTx (Table 3).…”

Section: Introductionmentioning

confidence: 99%

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2014

Exp Clin Transplant

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Liver retransplant is the only treatment for patients with irreversible graft failure. However, given the severe shortage of organs, there is an ethical question of equity in the distribution of this resource. Liver retransplant is more expensive and is associated with lower patient/graft survival rates than equivalent rates after primary transplant. Both primary nonfunction and hepatic artery thrombosis account for nearly all cases of early liver retransplant. Late indications of liver retransplantinclude chronic rejection, biliary complications, or recurrence of primary disease such as hepatitis C, autoimmune hepatitis, and primary sclerosing cholangitis. Donor data are not available when a patient is listed for liver retransplant; therefore, prognostic factors related to the recipient is a more practical way of making the decision to offer liver retransplant is made. In the Model of End-stage Liver Disease era liver retransplant for "late" indications is more complex and selection criteria are more stringent. We review the literature for predictive factors influencing outcome of liver retransplant, especially in those with recurrent disease.

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“…1 With an increasing population of LT patients at risk of eventual graft failure, re-LT demand is expected to increase. 3,4 Despite worse outcomes with re-LT, Eguchi et al 5 reported that allocating livers to those requiring re-LT could lead to more surviving patients and fewer deaths than if the re-LT grafts had been given to patients awaiting primary LT. Therefore, re-LT is still the only lifesaving therapy available for patients with failing primary liver grafts.…”

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confidence: 99%

Optimizing repeat liver transplant graft utility through strategic matching of donor and recipient characteristics

Hung

Gralla²,

Dodge³

et al. 2015

Liver Transpl

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Repeat liver transplantation (LT) is controversial because of inferior outcomes versus primary LT. A minimum 1-year expected post-re-LT survival of 50% has been proposed. We aimed to identify combinations of Model for End-Stage Liver Disease (MELD), donor risk index (DRI), and recipient characteristics achieving this graft survival threshold. We identified re-LT recipients listed in the United States from March 2002 to January 2010 with > 90 days between primary LT and listing for re-LT. Using Cox regression, we estimated the expected probability of 1-year graft survival and identified combinations of MELD, DRI, and recipient characteristics attaining >50% expected 1-year graft survival. Re-LT recipients (n 5 1418) had a median MELD of 26 and median age of 52 years. Expected 1-year graft survival exceeded 50% regardless of MELD or DRI in Caucasian recipients who were not infected with hepatitis C virus (HCV) of all ages and Caucasian HCV-infected recipients <50 years old. As age increased in HCV-infected Caucasian and non-HCV-infected African American recipients, lower MELD scores or lower DRI grafts were needed to attain the graft survival threshold. As MELD scores increased in HCV-infected African American recipients, lower-DRI livers were required to achieve the graft survival threshold. Use of high-DRI livers (>1.44) in HCVinfected recipients with a MELD score > 26 at re-LT failed to achieve the graft survival threshold with recipient age 60 years (any race), as well as at age 50 years for Caucasians and at age < 50 years for African Americans. Strategic donor selection can achieve >50% expected 1-year graft survival even in high-risk re-LT recipients (HCV infected, older age, African American race, high MELD scores). Low-risk transplant recipients (age < 50 years, non-HCV-infected) can achieve the survival threshold with varying DRI and MELD scores.

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Retransplantation of the Liver: Review of Current Literature for Decision Making and Technical Considerations

Cited by 47 publications

References 32 publications

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Optimizing repeat liver transplant graft utility through strategic matching of donor and recipient characteristics

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