Retransplantation of the liver in children

Background Because of the poor outcome of hepatic retransplantation, it is still debated whether this procedure should be performed in an era of donor organ scarcity. The aim of this study was to analyze outcome of hepatic re transplantation in children, to identify risk factors influencing this outc ome, and to assess morbidity and causes of death, Methods. A series of 97 children after a single trans plantation and 34 chi ldren with one retransplantation was analyzed. Results. The 1-, 3-, and 5-year survival of children with a retransplantati on was 70, 63, and 52%, respectively, compared with 85, 82, and 78%, respec tively, for children after a single transplantation (P=0.009), Survival of children with a retransplantation within 1 month after primary transplantat ion was worse (P=0.007) and survival of children with a late retransplantat ion was comparable (P=0.66) with single transplantation. In early retranspl antations, the Child-Pugh score was higher, do nors were older and weighed more, and more technical variant Liver grafts were used compared with singl e transplantations. Biliary atresia and a high Child-Pugh score were associ ated with decreased patient survival after retransplantation. Sepsis was th e most important complication and cause of death after retransplantation. Conclusions. Retransplantation is a significant event after pediatric liver transplantation. Outcome after hepatic retransplantation in children is in ferior compared with single transplantation. This difference is explained b y low survival after early retransplantation and can be explained by the po or clinical condition of the children at time of retransplantation, especia lly in children with biliary atresia, and by the predominant use of technic al variant liver grafts in retransplantations.