Excellent outcome after late retransplantation of the liver during the last decade

The need for late re-transplantation (RTx) grows in parallel with better  long-term survival after liver transplantation. RTx is the only solution for late graft failure, but it has been associated with inferior outcome compared to the primary transplantation. In contrast to early RTx for primary graft non- or dysfunction, late RTx is traditionally considered a challenging procedure because of massive perihepatic adhesions, recurrent portal hypertension, and effects of a long-term immunosuppressive treatment. The present study analyzes the results of late RTx at our institution during the last decade. Outcome parameters were patient's and graft's survival, morbidity, and operative parameters. Between January 1995 and June 2008, 56 patients underwent late RTx (>1 year after the first transplant). The main cause of late RTx was non-anastomotic biliary strictures (32%). The median time between the initial transplant and late RTx was 5.9 years (range 1.1-18.2 years). Overall 1-, 3- and 5-years patient's survival after RTx was 86%, 84%, and 78%, respectively. Overall graft's survival at the same time points was 70%, 66% and 60%, respectively. Median blood loss during RTx was 5.4 l (0.4-65.0) and median RBC transfusion was 6.5 units (0-44). Five patients (9%) did not require any RBC transfusion. Postoperative complications occurred in 75% of the patients and among them infectious complications were the most common (39%). In univariate analyses, the following variables were significantly associated with mortality after RTx: the need for a second or third RTx, pre-transplant Child-Pugh score, surgical technique (conventional technique versus piggy back), post-transplant ICU stay, intubation time, septic complications, and the need for reinterventions. However, after multivariate Cox regression analysis only septic complications remained as a significant independent predictor of patient survival. In conclusion, excellent short- and long-term survival can be obtained after late RTX of the liver. Postoperative sepsis is the main risk factor for poor outcome, indicating that adequate antimicrobial prophylaxis and microbiological surveillance are of great importance after late RTx.

Keywords: Liver Transplantation, clinical outcome