Trends and experiences in liver retransplantation over 15 years

Abstract

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,...

Therapeutic management of patients with gastroenteropancreatic neuroendocrine tumours

“…A small group of patients with bilobar liver metastases without extrahepatic disease can be considered for total tumour hepatectomy with liver transplantation in two situations: i) with the intent to cure or ii) to palliate from life-threatening hormonal disturbances (Blonski et al 2005, Pfitzmann et al 2007. In an analysis of all UK transplants for NETs, survival was 62% at 1 year and 23% at 5 years, similar to a study from France.…”

Opinião e conhecimento da população da cidade de curitiba sobre doação e transplante de órgãos

“…Entretanto, a disponibilidade de órgãos é muito menor do que a demanda para transplantes. Devido à falta de órgãos, a fila de espera e o número de pacientes que morrem enquanto aguardam o transplante, em vários países, inclusive nos Estados Unidos, Europa e Brasil são expressivos [5][6][7][8] . A carência de órgãos para transplantes tem motivado vários estudos e propostas para aumentar a captação de órgãos.…”

Short- and long-term outcomes of third liver transplantation at single centre

“…Careful analysis of the potential benefits of a third LT in light of recent improvements in surgical and medical treatments is essential to justify its role in the current era of organ shortage. Given the fact that a second LT is associated with decreased patient and graft survival as compared with a primary LT [2][3][4][5][6][7][8][9][10], comparable outcomes between a third and primary LT cannot be expected. Thus, we evaluated the surgical aspects and short-and long-term outcomes of third LT in the present study, and compared them to those of second LT, which is currently regarded as acceptable despite its inferior outcomes as compared to primary transplantation.…”

“…Second LT has been frequently discussed [2][3][4][5][6][7][8][9][10]. Despite strict patient selection, and improvements in surgical technique and post-transplant patient care, the results of second LT are inferior to those of primary LT, and a substantial number of patients experience irreversible graft failure following the second procedure [2,5,9,10].…”

“…Given the fact that a second LT is associated with lower patient and graft survival than a primary LT, it is reasonable that the outcome of a third LT will also be inferior to that of primary LT. Therefore, it is more practical to compare third LT outcomes to second LT outcomes to determine if a third LT has equivalent acceptability to a second procedure, which is considered worthwhile despite the risk of poor outcome [2,4,[6][7][8]10].…”