Predictive Index for Long-term Survival after Retransplantation of the Liver: Analysis of 26-Year Experience in a Single Center
Johnny C. Hong, MD*, Fady M. Kaldas, MD*, Henrik Petrowsky, MD*, Douglas G. Farmer, MD*, Hasan Yersiz, MD*, Prawat Kositamongkol, MD*, Gaurav Gupta, MD*, Abbas Rana, MD*, Daniela Markovic, MD*, Ronald W. Busuttil, MD
University of California, Los Angeles- School of Medicine, Los Angeles, CA
Liver retransplantation (ReLT) is a life saving treatment in patients with a failing allograft. Due to organ shortage, ReLT remains controversial because of inferior outcomes related to patient comorbidities and increased technical complexity. This study defines a predictive index of risk associated with ReLT to improve patient selection.
We conducted an analysis from our prospective database of 466 adult ReLT between February 1984 and September 2010. Mean follow-up was 3 years. Each independent predictor for allograft failure was assigned risk score points (RS), ranging from 1 to 3, based on severity of adverse effects: Low Risk (LR), RS = 0 to 2; Intermediate Risk (IR), RS= 3 to 4; and High Risk (HR), RS= 5 to7.
Of 466 patients, 418 (90%) underwent 1 ReLT while 48 (10%) received > 1 ReLT. Nine multivariate factors predictive of worse survival outcomes and corresponding RS are shown (Table). 5-year patient survival was significantly higher in LR compared to IR and HR groups (Figure).
CONCLUSIONS:Liver retransplantation for patients with low and intermediate risk criteria resulted in excellent and acceptable long-term survival outcome respectively. This predictive index can be applied clinically to facilitate donor-recipient matching and optimize outcomes after ReLT.
|Previous no. of liver transplantation =/> 2||3|
|Intraoperative transfusion > 30 units PRBC||3|
|Serum albumin <2.5 mg/dL before ReLT||2|
|Requirement for ventilator before ReLT||2|
|Donor age > 45 yrs.||2|
|Partial liver graft||2|
|Recipient age > 55 yrs.||1|
|Requirement for dialysis before ReLT||1|
|MELD score > 30||1|
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