HEPATIC RETRANSPLANTATION IN NEW-ENGLAND - A REGIONAL EXPERIENCE AND SURVIVAL MODEL

Hepatic retransplantation (reTx) offers the only alternative to death for patients who have failed primary hepatic transplantation (PTx). As suming a finite number of donor organs, reTx also denies the chance of survival for some patients awaiting PTx. The impact of reTx on overal l survival (i.e., the survival of all candidates for transplantation) must therefore be clarified. Between 1983 and 1991, 651 patients from the New England Organ Bank underwent liver transplantation, and 73 reT x were performed in 71 patients (11% reTx rate). The 1-year actuarial survival for reTx (48%) was significantly less than for PTx (70%, P<0. 05). This survival varied, dependent on the interval of time following PTx in which the reTx was performed (0-3 days, 57% survival; 4-30 day s, 24%; 30-365 days, 54%; and >365 days, 83%). Patients on the regiona l waiting list had an 18% mortality rate while awaiting transplantatio n. These results were incorporated into a mathematical model describin g survival as a function of reTx rate, assuming a limited supply of do nor livers. ReTx improves the 1-year survival rate for patients underg oing PTx but decreases overall survival (survival of all candidates) f or liver transplantation. In the current era of persistently insuffici ent donor numbers, strategies based on minimizing the use of reTx, esp ecially in the case of patients in whom chances of success are minimal , will result in the best overall rate of patient survival.