What is the prognosis after retransplantation of the liver?
ABSTRACT In patients with failing liver grafts, hepatic retransplantation cannot be abandoned for the ethical and practical reasons that have been detailed previously. The current recommendations involve a strategy for risk stratification of retransplant candidates. The long-term patient and graft survival outcomes after ReLT are excellent and acceptable for the low and intermediate groups, respectively. However, pursuing ReLT in transplant candidates in the high-risk category cannot be recommended. Furthermore, ReLT should be reserved for centers equipped to manage the difficulties of the endeavor because it is a technically demanding operation that requires surgical expertise and excellent anesthesiology and critical care support both before and after transplantation.
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ABSTRACT: Surgical site infection (SSI) after liver transplantation (LT) is associated with increased risk of graft loss and death. The incidence and risk factors of SSI following LT have been determined for primary, but not secondary LT. The importance of reporting SSI incidence risk stratified by primary versus secondary LT is not known. All (152) patients undergoing a second LT at a single institution between 2003 and 2011 were reviewed. The Kaplan-Meier method was used to estimate cumulative SSI incidence. Relative risks (RRs) and 95% confidence intervals (CIs) from Cox proportional hazards regression models were used to evaluate associations of potential risk factors with SSI after second LT. Thirty-one patients developed SSI (6 superficial, 1 deep, 24 organ/space). Cumulative 30-day post-LT SSI incidence was 21% (95% CI: 14%-27%), which was slightly, but not significantly higher than the previously reported SSI incidence after primary LT at our institution between 2003 to 2008, which was16% (RR: 1.32, 95% CI: 0.90 – 1.93, P=0.16). Units of red blood cells (RBC) transfused (RR: 1.38 [doubling], 95% CI: 1.02 – 1.86, p=0.037) and hepaticojejunostomy (RR: 2.22, 95% CI: 1.05-4.72, p=0.038) were the only factors associated with SSI after second LT in single variable analysis. The associations weakened in multivariable analysis (P=0.073 and P=0.067, respectively), potentially due to the correlation of RBC transfusion and hepaticojejunostomy (p=0.083). Incidence of SSI after second LT was slightly higher, but not significantly different than the published incidence of SSI (16%) after first LT at the same institution. Significant independent risk factors for SSI after second LT were not identified. Risk stratification for re-transplantation may not be necessary when reporting SSI incidence after LT. Liver Transpl , 2014. © 2014 AASLD.Liver Transplantation 08/2014; 20(8). DOI:10.1002/lt.23890 · 3.79 Impact Factor
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ABSTRACT: Hepatic retransplant accounts for 5% to 15% of liver transplants in most series and is associated with significantly increased hospital costs and inferior patient survival when compared with primary liver transplant. Early retransplants are usually due to primary graft nonfunction or vascular thrombosis, whereas later retransplants are most commonly necessitated by chronic rejection or recurrent primary liver disease. Hepatic retransplant remains the sole option for survival in many patients facing allograft failure after liver transplant. With improved techniques to match retransplant candidates with appropriate donor grafts, it is hoped that the outcomes of retransplant will continue to improve in future.
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ABSTRACT: Development of biliary strictures after liver transplantation is not uncommon, and minimally invasive procedures are the first-line treatment of choice in most centers. Hemobilia is an infrequent, usually self-limited complication related to the initial biliary access procedure. Massive hemobilia with severe hemodynamic instability is a rare event, particularly as a delayed complication. The difficulty of obtaining surgical access makes management of this condition highly challenging. Endovascular embolization may represent an important treatment option in this setting.Transplantation Proceedings 07/2014; 46(6):1889-91. DOI:10.1016/j.transproceed.2014.05.022 · 0.95 Impact Factor