American Surgical Association

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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

OBJECTIVE(S):
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.
METHODS:
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.
RESULTS:
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.
Independent Predictors on Multivariate Analysis and Assigned Risk Score
Risk FactorsRS
Previous no. of liver transplantation =/> 23
Intraoperative transfusion > 30 units PRBC3
Serum albumin <2.5 mg/dL before ReLT2
Requirement for ventilator before ReLT2
Donor age > 45 yrs.2
Partial liver graft2
Recipient age > 55 yrs.1
Requirement for dialysis before ReLT1
MELD score > 301


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