Shah JA, Patel MS, Kratz JR, Markmann JF, Vagefi PA

Language: English
References: 21
Page: 888-894
PDF size: 149.78 Kb.

ABSTRACT

Background. Liver re-transplantation (re-OLT) remains the only feasible option for patients with graft failure following liver transplantation. Sparse resources and a growing waitlist mandate that available grafts are allocated properly. We studied the differences in patient demographics, characteristics, and survival for those listed for re-OLT in a region with prolonged wait times. Material and methods. We performed a single-center retrospective study, from 2005 to 2013, of adult candidates listed for liver re-OLT at a tertiary care center within United Network for Organ Sharing (UNOS) region 1. Results. Of the 48 patients listed for re-OLT, 1(2%) improved while waiting, 14(29%) died while waiting, and 33(69%) underwent re-OLT. Those re-transplanted represented 11% of the center’s adult liver transplant volume during the same time period. Comparing those who died while waiting to those who achieved re-OLT, there was no significant difference in age (median 52 vs. 48 years, p=0.56) or MELD at second listing (median 29 vs. 26, p = 0.90). Waitlisted candidates who failed to achieve re-transplant died on average of 15.5 days (IQR 36 days) days after re-listing. Those re-transplanted achieved 3-year survival of 70% and there was no significant difference in 3-year survival of those re-transplanted within or beyond 90 days of first transplant (70% vs. 69.5%, p = 0.28). Conclusions. In conclusion, re-OLT is the only viable option for candidates with nonreversible liver graft failure. Inability to achieve re-OLT leads to nearly assured and expeditious death. Despite technical challenges, in experienced hands excellent long term survival following re-OLT can be achieved.

REFERENCES

1. 1 UNOS. Transplant Trends. 2015. Available from: https:// www.unos.org/data/transplant-trends/#transplants _by_organ_type+year+2014. Accessed July 17, 2015.

2. Ubel PA, Arnold RM, Caplan AL. Rationing failure. The ethical lessons of the retransplantation of scarce vital organs. JAMA 1993; 270: 2469-74.

3. Dudek K, Nyckowski P, Zieniewicz K, Michalowicz B, Pawlak J, Malkowski P, Krawczyk M. Liver retransplantation: Indications and results. Transplant Proc 2002; 34: 638-9.

4. Biggins SW, Beldecos A, Rabkin JM, Rosen HR. Retransplantation for hepatic allograft failure: Prognostic modeling and ethical considerations. Liver Transplant 2002; 8: 313-22.

5. Reed A, Howard RJ, Fujita S, Foley DP, Langham MR, Schold JD, Nelson D, et al. Liver retransplantation: A single-center outcome and financial analysis. Transplant Proc 2005; 37: 1161-3.

6. Azoulay D, Linhares MM, Huguet E, Delvart V, Castaing D, Adam R, Ichai P, et al. Decision for retransplantation of the liver: an experience and cost-based analysis. Ann Surg 2002; 236: 713-21.

7. D’Alessandro AM, Ploeg RJ, Knechtle SJ, Pirsch JD, Stegall MD, Hoffmann R, Sollinger HW, et al. Retransplantation of the liver-a seven-year experience. Transplantation 1993; 55: 1083-7.

8. Markmann JF, Markowitz JS, Yersiz H, Morrisey M, Farmer DG, Farmer DA, Goss J, et al. Long-term survival after retransplantation of the liver. Ann Surg 1997; 226: 408-18.

9. Markmann JF, Gornbein J, Markowitz JS, Levy MF, Klintmalm GB, Yersiz H, Morrisey M, et al. A simple model to estimate survival after retransplantation of the liver. Transplantation 1999; 67: 422-30.

10. Ghobrial RM. Retransplantation for recurrent hepatitis C. Liver Transplant 2002; 8: S38-S43.

11. Kim WR, Wiesner RH, Poterucha JJ, Therneau TM, Malinchoc M, Benson JT, Crippin JS, et al. Hepatic retransplantation in cholestatic liver disease: Impact of the interval to retransplantation on survival and resource utilization. Hepatology 1999; 30: 395-400.

12. Watt KDS, Lyden ER, McCashland TM. Poor survival after liver retransplantation: Is hepatitis C to blame? Liver Transplant 2003; 9: 1019-24.

13. Facciuto M, Heidt D, Guarrera J, Bodian CA, Miller CM, Emre S, Guy SR, et al. Retransplantation for late liver graft failure: predictors of mortality. Liver Transplant 2000; 6: 174-9.

14. Zimmerman MA, Ghobrial RM. When shouldn’t we retransplant? Liver Transplant 2005; 11: 14-20.

15. Doyle MBM, Subramanian V, Vachharajani N, Maynard E, Shenoy S, Wellen JR, Lin Y, et al. Results of Simultaneous Liver-Kidney Transplantation: A Single Center Review. J Am Coll Surg 2016 (In Press).

16. Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, Poole C, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology 2007; 18: 805-35.

17. Doyle HR, Morelli F, McMichael J, Doria C, Aldrighetti L, Starzl TE, Marino IR. Hepatic Retransplantation-an analysis of risk factors associated with outcome. Transplantation 1996; 61: 1499-505.

18. Watt KDS, Menke T, Lyden E, McCashland TM. Mortality while awaiting liver retransplantation: Predictability of MELD scores. Transplant Proc 2005; 37: 2172-3.

19. Coilly A, Roche B, Duclos-Vallée JC, Samuel D. Optimal therapy in hepatitis C virus liver transplant patients with direct acting antivirals. Liver Int 2015; 35: 44-50.

20. Powelson JA, Cosimi AB, Lewis WD, Rohrer RJ, Freeman RB, Vacanti JP, Jonas M, et al. Hepatic retransplantation in New England-a regional experience and survival model. Transplantation 1993; 55: 802-6.

21. Morel P, Rilo HL, Tzakis AG, Todo S, Gordon RD, Starzl TE. Liver retransplantation in adults: overall results and determinant factors affecting the outcome. Transplant Proc 1991; 23: 3029-31.