Early liver retransplantation in adults
Corresponding Author
Abbas Rana
Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ, USA
Correspondence
Dr. Abbas Rana MD, Division of Abdominal Transplantation, Department of Surgery, University of Arizona, 1501 N, Campbell Avenue, Tucson, AZ 85718, USA. Tel.: +1 520 626 6211; fax: +1 520 626 9226; e-mail: [email protected]
Search for more papers by this authorHenrik Petrowsky
Department of Surgery, Swiss HPB and Transplant Center Zurich, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorBruce Kaplan
Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ, USA
Search for more papers by this authorTun Jie
Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ, USA
Search for more papers by this authorMarian Porubsky
Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ, USA
Search for more papers by this authorShahid Habib
Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ, USA
Search for more papers by this authorHoracio Rilo
Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ, USA
Search for more papers by this authorAngelika C. Gruessner
Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ, USA
Search for more papers by this authorRainer W. G. Gruessner
Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ, USA
Search for more papers by this authorCorresponding Author
Abbas Rana
Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ, USA
Correspondence
Dr. Abbas Rana MD, Division of Abdominal Transplantation, Department of Surgery, University of Arizona, 1501 N, Campbell Avenue, Tucson, AZ 85718, USA. Tel.: +1 520 626 6211; fax: +1 520 626 9226; e-mail: [email protected]
Search for more papers by this authorHenrik Petrowsky
Department of Surgery, Swiss HPB and Transplant Center Zurich, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorBruce Kaplan
Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ, USA
Search for more papers by this authorTun Jie
Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ, USA
Search for more papers by this authorMarian Porubsky
Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ, USA
Search for more papers by this authorShahid Habib
Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ, USA
Search for more papers by this authorHoracio Rilo
Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ, USA
Search for more papers by this authorAngelika C. Gruessner
Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ, USA
Search for more papers by this authorRainer W. G. Gruessner
Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ, USA
Search for more papers by this authorConflict of interest: The authors have declared no conflict of interests.
Summary
Up to 23% of liver allografts fail post-transplant. Retransplantation is only the recourse but remains controversial due to inferior outcomes. The objective of our study was to identify high-risk periods for retransplantation and then compare survival outcomes and risk factors. We performed an analysis of United Network for Organ Sharing (UNOS) data for all adult liver recipients from 2002 through 2011. We analyzed the records of 49 288 recipients; of those, 2714 (5.5%) recipients were retransplanted. Our analysis included multivariate regression with the outcome of retransplantation. The highest retransplantation rates were within the first week (19% of all retransplantation, day 0–7), month (20%, day 8–30), and year (33%, day 31–365). Only retransplantation within the first year (day 0–365) had below standard outcomes. The most significant risk factors were as follows: within the first week, cold ischemia time >16 h [odds ratio (OR) 3.6]; within the first month, use of split allografts (OR 2.9); and within the first year, use of a liver donated after cardiac death (OR 4.9). Each of the three high-risk periods within the first year had distinct causes of graft failure, risk factors for retransplantation, and survival rates after retransplantation.
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