LONG-TERM SURVIVAL AFTER RETRANSPLANTATION OF THE LIVER

Objective The authors determined the long-term outcome of patients und ergoing hepatic retransplantation at their institution. Donor, operati ve, and recipient factors impacting on outcome as well as parameters o f patient resource utilization were examined. Summary Background Data Hepatic retransplantation provides the only available option for liver transplant recipients in whom an existing graft has failed. However, such patients are known to exhibit patient and graft survival after re transplantation that is inferior to that expected using the same organ s in native recipients. The critical shortage of donor organs and resu ltant prolonged patient waiting periods before transplantation prompte d the authors to evaluate the results of a liberal policy of retranspl antation and to examine the factors contributing to the inferior outco me observed in retransplanted patients. Methods A total of 2053 liver transplants were performed al the UCLA Medical Center during a 13-year period from February 1, 1984, to October 1, 1996. A total of 356 retr ansplants were performed in 299 patients (retransplant rate = 17%). Mu ltivariate regression analysis was performed to identify variables ass ociated with survival. Additionally, a case-control comparison was per formed between the last 150 retransplanted patients and 150 primarily transplanted patients who were matched for age and United Network of O rgan Sharing (UNOS) status. Differences between these groups in donor, operative, and recipient variables were studied for their correlation with patient survival. Days of hospital and intensive care unit stay, and hospital charges incurred during the transplant admissions were c ompared for retransplanted patients and control patients. Results Surv ival of retransplanted patients at 1, 5, and 10 years was 62%, 47%, an d 45%, respectively. This survival is significantly less than that see n in patients undergoing primary hepatic transplantation at the author s' center during the same period (83%, 74%, and 68%). A number of vari ables proved to have a significant impact on outcome including recipie nt age group, interval to retransplantation, total number of grafts, a nd recipient UNOS status. Recipient primary diagnosis, cause for retra nsplantation, and whether the patient was retransplanted before or aft er June 1, 1992, did not reach statistical significance as factors inf luencing survival. In the case-control comparison, the authors found t hat of the more than 25 variables studied, only preoperative ventilato r status showed both a significant difference between control patients and retransplanted patients and also was a factor predictive of survi val in retransplanted patients. Retransplant patients had significantl y longer hospital and intensive care unit stays and accumulated total hospitalization charges more than 170% of those by control patients. C onclusions Hepatic retransplantation, although life-saving in almost 5 0% of patients with a failing liver allograft, is costly and uses scar ce donor organs inefficiently. The data presented define patient chara cteristics and preoperative variables that impact patient outcome and should assist in the rational application of retransplantation.