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Predictive index for long-term survival after retransplantation of the liver in adult recipients: analysis of a 26-year experience in a single center.

Abstract：

OBJECTIVE:To develop a prognostic scoring system for risk stratification of patients with hepatic graft failure (GF) undergoing retransplants of the liver (ReLT) and improve patient selection. SUMMARY OF BACKGROUND DATA:Retransplantation of the liver remains controversial because of inferior outcomes compared with the primary orthotopic liver transplantation (OLT) and raises concerns of inappropriate utilization of a scarce donor organ resource. Data on risk stratification of ReLT patients for long-term survival outcomes are limited. METHODS:We conducted an analysis from our prospective database of 466 adults' ReLT between February 1984 and September 2010. Mean follow-up was 3 years. Each independent predictor for allograft failure was assigned risk score (RS) points of 1 or 2, proportional to the corresponding parameter estimate under the Cox model: Predictive index category (PIC) 1, RS = 0; PIC II, RS = 1 to 2; PIC III, RS = 3 to 4; and PIC IV, RS = 5 to 12. RESULTS:Eight risk factors predictive for GF after ReLT included recipient age greater than 55 years, Model for End-Stage Liver Disease score greater than 27, history of prior OLT greater than 1, pre-ReLT requirement for mechanical ventilation, serum albumin less than 2.5 g/dL, donor age greater than 45 years, intraoperative requirement of packed red blood cell transfusion greater than 30 units, and performance of ReLT between 15 and 180 days from the prior OLT. Five-year GF-free survival was significantly higher in PIC I (65%) than in PIC II (53%), PIC III (43%), and PIC IV (20%) groups (P < 0.001). CONCLUSIONS:This risk-stratification model was highly predictive of long-term outcome after liver retransplantation in adult recipients. This formula provides a practical guide for selection of candidates for retransplantation of the liver that can lead to improved patient outcomes and optimal utilization of a scarce resource.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Hong JC,Kaldas FM,Kositamongkol P,Petrowsky H,Farmer DG,Markovic D,Hiatt JR,Busuttil RW

doi

10.1097/SLA.0b013e31822c5878

subject

Has Abstract

pub_date

2011-09-01 00:00:00

pages

444-8; discussion 448-9

issue

eissn

0003-4932

issn

1528-1140

journal_volume

254

pub_type

杂志文章

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Predictive index for long-term survival after retransplantation of the liver in adult recipients: analysis of a 26-year experience in a single center.