Retransplantation for late liver graft failure: Predictors of mortality

As patient survival after orthotopic liver transplantation (OLT) improves, late complications, including late graft failure, more commonly occur and r etransplantation (re-OLT) is required more often. Survival after re-OLT is poorer than after primary OLT, and given the organ shortage, it is essentia l that we optimize our use of scarce donor livers. We sought to identify va riables that predict poor outcome after late re-OLT. Among adults who under went OLT between September 1989 and October 1997, we identified transplant recipients who survived greater than 6 months (n = 964) and analyzed those who required late re-OLT (greater than or equal to 6 months after primary O LT). We recorded the indication for the initial OLT and interval from OLT t o re-OLT. We also analyzed data collected at the time of re-OLT, including age, sex, indications for primary OLT and re-OLT, United Network for Organ Sharing status, preoperative laboratory values (white blood cells, platelet s, hemoglobin, albumin, bilirubin, creatinine, and prothrombin time), Child -Pugh-Turcotte score, number of rejection episodes before re-OLT, and inter val between OLT and re-OLT, In addition, we analyzed surgical factors (incl uding procedure performed and use of packed red blood cells, fresh frozen p lasma and platelets), postoperative immunosuppression, and donor factors (a ge, ischemic time). Forty-eight patients (5%) underwent late re-OLT at a me dian of 557 days (range, 195 to 2,559 days) post-OLT. Survival rates after re-OLT at 90 days, 1 year, and 5 years were 71%, 60%, and 42%, respectively . Patients surviving 90 days or greater after re-OLT had an 85% chance of s urviving to 1 year. Sepsis was the leading cause of death (15 of 25 deaths; 60%). Recipient age older than 50 years (P =.04), preoperative creatinine level greater than 2 mg/dL (P =.004), and use of intraoperative blood produ cts (packed red blood cells, P =.001; fresh frozen plasma, P =.002; platele ts, P =.004) had significant impacts on survival. Late re-OLT was associate d with increased mortality. Careful patient selection, with particular atte ntion to recipient age and renal function, may help improve results and opt imize our use of scarce donor livers. Copyright (C) 2000 by the American As sociation for the Study of Liver Diseases.