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Risk factors for death following liver retransplantation.

Abstract：

AIM:Our goal was to retrospectively analyze graft loss and mortality risk factors using multi-centre data on liver retransplantation. MATERIAL AND METHODS:Between 1991-1995, 640 patients underwent 718 liver transplants in Barcelona. Mean age of the 74 patients receiving a second transplant was 47.6 years (range 19-65). Causes of retransplantation were immunologic in 26 patients (35.1%), technical in 23 (31.1%), primary dysfunction in 12 (16.2%), recurrent original disease in 7 (9.5%), and other causes in 6 (8.1%). Mean time between first and second transplant was less than 7 days in 20 patients (27%), between 8 and 30 days in 4 (5.4%) and more than 30 days in 50 patients (67.6%). Recipient, donor, and operative variables were analyzed using univariate (Kaplan-Meier curves) and multivariate techniques (Cox regression) to identify risk factors. RESULTS:Retransplant patient survival at 1 and 5 years was 60.8% and 49.5%, respectively, compared to 75.6% and 64.8% in a series of 640 first transplant patients. Mortality risk factors identified by multivariate analysis were bilirubin >12 mg/dL (RR 2.3; P=.010), recipient age (RR increase 0.04 for each additional year; P=.02), cause for retransplant (immunologic RR 4.01, technical RR 2.7 and other causes RR 6.9; compared to primary dysfunction RR 1; P=.020). Urea >54 mg/dL (0.02) and multiple transfusions >15 units red blood cells (0.001) were only significant in the univariate analysis. CONCLUSIONS:In our experience, retransplantation for primary dysfunction is the setting that has the best prognosis. Of the other causes, retransplantation should be performed before the total bilirubin reaches >12 mg/dL or before the appearance of variables indicative of severe renal insufficiency.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Bilbao I,Figueras J,Grande L,Clèries M,Jaurrieta E,Visa J,Margarit C

doi

10.1016/s0041-1345(03)00585-2

subject

Has Abstract

pub_date

2003-08-01 00:00:00

pages

1871-3

issue

5

eissn

0041-1345

issn

1873-2623

pii

S0041134503005852

journal_volume

35

pub_type

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