CLINICAL CHARACTERISTICS AFFECTING THE OUTCOME OF LIVER RETRANSPLANTATION

Background. The outcome of retransplantation remains unsatisfactory wh en compared with primary transplantation of the liver, The aim of the present study tvas to determine which preoperative clinical and labora tory risk variables are implicated in the poorer outcome. Methods. The preoperative status of 70 retransplanted patients was compared with a group of 303 time-matched recipients receiving their first graft. Res ults. Survival. at 1 year was reduced in the retransplant versus the p rimary transplant group (50% vs, 80%, P<0.001). Preoperatively older a ge, high United Network of Organ Sharing score, inpatient status, elev ated bilirubin, and creatinine levels were associated with increased m ortality after a second transplant. Preoperatively, the retransplant g roup had higher encephalopathy grades, were more likely to he inpatien ts, and had higher serum creatinine, bilirubin, and white cell levels than the primary recipients (P<0.05 in all cases). The median length o f inpatient stay was longer after the second transplant (25 vs. 19 day s, P<0.001). Conclusions. These factors assist in the stratification o f patients awaiting retransplantation; however, the outcome of this pr ocedure is only likely to be improved with an earlier identification o f the patients whet require it, along with an increased priority in or gan allocation.