Prognostic Factors and Outcomes of Patients After Liver Retransplantation

• Retransplantation of the liver provides good outcomes in selected groups of patients.
• Blood product transfusions and preoperative hemoglobin concentration are prognostic factors.
• The perioperative period is the major determinant of the patient's prognosis.

BackgroundDespite great progress and improvement in results of orthotopic liver transplantation (OLTx), 10%–20% of patients still require retransplantation (re-OLTx). The aim of the study was to present long-term results of liver retransplantation and to determine the factors influencing outcomes.Patients and MethodsFrom December 1994 to July 2014, a total of 1461 liver transplantations were performed in the Department of General, Transplant and Liver Surgery of Medical University of Warsaw. There were 92 retransplantations (6.3%), including 40 early re-OLTx (up to 30 days). The most common indication for re-OLTx were vascular complications (41/92, 44.6%). Influence of clinical variables on short- and long-term outcomes was analyzed.ResultsPostoperative mortality was 30.4% (28/92). One-year, 3-year and 5-year survival for all patients was 59.8%, 56.5% and 54.1%, respectively. The best results were achieved in patients undergoing retransplantation due to chronic rejection and biliary complications, whose 5-year survival rates were 75.0% and 72.9% respectively. There was no difference in long-term survival after early and late retransplantations (60.9% and 49.3%, respectively; P = .158). Multivariable analysis revealed factors associated with longer survival of patients, namely, higher preoperative hemoglobin concentration (P = .001), increased blood transfusions (P = .048), and decreased fresh frozen plasma transfusions (P = .004).ConclusionsLiver retransplantation is a method providing satisfactory outcomes in selected patients. The perioperative period has a major impact on patient outcome.