engleski

LIVER RETRANSPLANTATION IN ADULTS: ACROATIAN SINGLE-CENTRE EXPERIENCE

Background: Liver retransplantation (re-LT) is the only treatment option for patients with irreversible graft failure. However, it is associated with poorer outcome compared with the primary LT. The aim of this study was to analyze a single center’s experience with re-LT for patients with poor graft function after primary LT. Methods: This is a retrospective analysis of indications, timing, surgical techniques and outcomes of patients who underwent re-LTs after primary LT between 2000 and 2017 in our center. Results: Of the 1012 primary LTs, 73 (7.2%) patients required a first and 11(1.1%) a second re-LT. Alcoholic liver disease (45.8%) was the most common diagnosis, followed by chronic hepatitis C (25%) for the primary LT. Majority of re-LTs were performed within 6 months, early (16.4%, day 0–7 ; 19.2%, day 8–30)and intermediately (24.7%, 1–6 months), of primary LT. Major indications for the first re-LT were: biliary complications (28.8%), hepatic artery thrombosis (23.3%), recurrent diseases (viral/autoimmune, 21.9%) and primary graft non- function(16.4%). All re-LT patients underwent modified piggyback LT with cadaveric allografts, in 45.2% of cases with hepatico-jejunal anastomosis. The 1-, 3-, 5- and10-patient survival rates after first re-LTs were 61.6%, 60.0%, 51.8% and 46%, respectively. Survival of patients with re-LT within 6 months, was significantly poorer than of those re- transplanted later (p=0.007). The 1- and 3- patientsurvivalaftersecondre- LTwas53%.Sepsisrelatedmultiple-organ failure was the most common cause of death in 72.3% of cases after re-LTs.Conclusion: Liver retransplantation offers acceptable patient survival. Early re-LTs show worse outcomes than later ones. It is up to individual transplant program to decide whether to perform multiple LTs based on organ availability, center’s volume, and patients’ outcomes

LIVER RETRANSPLANTATION ; GRAFT FAILURE

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