RETRANSPLANTATION OF THE LIVER - A 7-YEAR EXPERIENCE

Three hundred and four patients underwent 362 liver transplants betwee n July 1984 and April 1992. Fifty-eight retransplants were performed i n 44 patients (14.5%). Thirty-four patients underwent two (77.3%), sev en patients three (15.9%), two patients four (4.5%), and one patient f ive (2.3%) transplants. Poor function accounted for 23 retransplants ( 6.4%), technical problems for 19 retransplants (5.2%), and rejection f or 15 retransplants (4.1%). One-month patient survivals after retransp lantation for poor function, technical problems, or rejection were sim ilar (79.0%, 73.4%, and 80.0%, respectively). No difference in retrans plantation rates were seen between adults and children receiving whole liver transplants (WLT) (11.6% versus 19.1%). However, retransplantat ion for poor function was more common in pediatric recipients receivin g reduced-size liver transplants (RLT) (20.0% versus 0.0%, P<0.01), wh ile retransplantation for hepatic artery thrombosis (HAT) was more com mon in pediatric recipients receiving WLT (16.7% versus 2.8%, P<0.05). The presence of multiorgan system failure of greater than four was as sociated with a high mortality (90%), whereas patients undergoing emer gent retransplantation who had less than four systems fail had a survi val of 73.9% and patients who underwent elective retransplantation had a survival rate of 81.8%. Length of stay and cost of liver transplant ation was higher in patients undergoing retransplantation when compare d with primary transplants (29.7+/-14.9 days versus 58.4+/-38.9 days a nd $122,358+/-59,782 versus $289,302+/-126,907, P<0.01). The overall a ctuarial one-year patient survival in primary transplants was 86.6% an d in retransplants 74.8%, and at five years these were 71.4% versus 62 .5%, respectively (P<0.05). Our results support continued retransplant ation of the liver unless the patient's medical condition dictates oth erwise.