Hepatic retransplantation in cholestatic liver disease: Impact of the interval to retransplantation on survival and resource utilization

The aim of our study was to quantitatively assess the impact of hepatic ret ransplantation on patient and graft survival and resource utilization. We s tudied patients undergoing hepatic retransplantation among 447 transplant r ecipients with primary biliary cirrhosis (PBC) and primary sclerosing chola ngitis (PSC) at 3 transplantation centers. Cox proportional hazards regress ion analysis was used for survival analysis. Measures of resource utilizati on included the duration of hospitalization, length of stay in the intensiv e care unit, and the duration of transplantation surgery. Forty-six (10.3%) patients received 2 or more grafts during the follow-up period (median, 2. 8 years). Patients who underwent retransplantation had a 3.8-fold increase in the risk of death compared with those without retransplantation (P <.01) , Retransplantation after an interval of greater than 30 days from the prim ary graft was associated with a 6.7-fold increase in the risk of death (P < .01). The survival following retransplantations performed 30 days or earlie r was similar to primary transplantations. Resource utilization was higher in patients who underwent multiple consecutive transplantations, even after adjustment for the number of grafts during the hospitalization. Among chol estatic liver disease patients, poor survival following hepatic retransplan tation is attributed to late retransplantations, namely those performed mor e than 30 days after the initial transplantation. While efforts must be mad e to improve the outcome following retransplantation, a more critical evalu ation may be warranted for late retransplantation candidates.