Study of re-transplantation and prognosis in liver transplant center in Iran
Gastroenterology and Hepatology from Bed to Bench,
26 April 2021
Background: due to the problem of organ shortage and high demand of liver transplantation among patients, this problem has been exacerbated, thus providing more information on the causes of liver re-transplantation and its prognosis and other related issues to this procedure is of great importance. The aim of this study was to investigate the causes of liver re-transplantation in patients referred to Imam Khomeini Hospital Liver Transplantation Center and also the prognosis of this re-transplantation.
Methods: This study was conducted in 2018 as a historical cohort. In this study, the records of liver transplantation patients at Imam Khomeini Hospital Liver Transplantation Center between 2000 to 2016 and were studied. Required data were extracted from the records of patients undergoing liver transplantation. Patients' data were entered SPSS 20 software and analyzed.
Results: In this study 1030 patients with mean age of 43.15 ± 14.57 years were studied. There were 426 women (41.4%) and 604 men (58.6%). The number of primary transplants was 966 with a mean age of 43.19 ± 14.72 and the number of re-transplants 64 with a mean age of 42.56 ± 12.82. Significant differences were found between the two groups in terms of MELD and CHILD scores, cold ischemic time, total and direct bilirubin levels, liver function factors (ALT, AST, and alkaline phosphatase), hemoglobin, and WBC. There was no significant difference between the two groups in terms of age, sex and platelets (> 0.05). The mortality rate was 241 (23.39%) in all patients and the mortality rate was 206 (21.32%) and in liver transplant patients was 35 (54.68%). The mortality rate in the transplant group was statistically higher (> 0.001). Secondary is primary non-functional graft (PNF) (37.5%) with 1, 3- and 5-years survival rates of 82%, 81% and 70% in primary group and 59%, 43% and 32% in re-transplantation. There was a significant difference in survival between the two groups (P <0.05). Hemoglobin and alkaline phosphatase were predictors of survival rates in transplant patients.
Conclusion: The results of this study showed that survival rate in re-transplant patients was significantly lower than primary transplant and mortality rate in re-transplant patients was significantly higher.
Key words: liver re-transplant; prognosis; Survival
- liver re-transplant
Sahani, D., et al., Evaluation of living liver transplant donors: method for precise anatomic definition by using a dedicated contrast-enhanced MR imaging protocol. Radiographics, 2004. 24(4): p. 957-967.
Busuttil, R.W., et al., Analysis of long-term outcomes of 3200 liver transplantations over two decades: a single-center experience. Annals of surgery, 2005. 241(6): p. 905.
Jain, A., et al., Long-term survival after liver transplantation in 4,000 consecutive patients at a single center. Annals of surgery, 2000. 232(4): p. 490.
Hong, J.C., et al., Predictive index for long-term survival after retransplantation of the liver in adult recipients: analysis of a 26-year experience in a single center. Annals of surgery, 2011. 254(3): p. 444-449.
Azoulay, D., et al., Decision for retransplantation of the liver: an experience-and cost-based analysis. Annals of surgery, 2002. 236(6): p. 713.
Pour-Reza-Gholi, F., et al. Kidney retransplantation in comparison with first kidney transplantation. in Transplantation proceedings. 2005. Elsevier.
Morel, P., et al., Pancreas retransplants compared with primary transplants. Transplantation, 1991. 51(4): p. 825-833.
Schnetzler, B., et al., Heart retransplantation: a 23-year single-center clinical experience. The Annals of thoracic surgery, 1998. 65(4): p. 978-983.
Smith, J.A., et al., Heart retransplantation: the 25-year experience at a single institution. The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation, 1995. 14(5): p. 832-839.
Kawut, S.M., et al., Outcomes after lung retransplantation in the modern era. American journal of respiratory and critical care medicine, 2008. 177(1): p. 114-120.
Compagnon, P. and C. Toso, Selective retransplantation after late hepatic artery thrombosis. Transplant International, 2019. 32(5): p. 470-472.
Memeo, R., et al., Repeat liver retransplantation: rationale and outcomes. Clinical transplantation, 2016. 30(3): p. 312-319.
Rosen, H.R., et al., Validation and refinement of survival models for liver retransplantation. Hepatology, 2003. 38(2): p. 460-469.
Bilbao, I., et al. Risk factors for death following liver retransplantation. in Transplantation proceedings. 2003. Elsevier.
Uemura, T., et al., Liver retransplantation for primary nonfunction: analysis of a 20‐year single‐center experience. Liver transplantation, 2007. 13(2): p. 227-233.
Yoong, K., et al. Impact of donor liver microvesicular steatosis on the outcome of liver retransplantation. in Transplantation proceedings. 1999. Elsevier.
Pareja, E., et al. Vascular complications after orthotopic liver transplantation: hepatic artery thrombosis. in Transplantation proceedings. 2010. Elsevier.
Detry, O., et al., Donor age as a risk factor in donation after circulatory death liver transplantation in a controlled withdrawal protocol programme. British journal of Surgery, 2014. 101(7): p. 784-792.
Linares, I., et al., Steatosis in liver transplantation: current limitations and future strategies. Transplantation, 2019. 103(1): p. 78-90.
Watt, K., et al. Mortality while awaiting liver retransplantation: predictability of MELD scores. in Transplantation proceedings. 2005. Elsevier.
Rosen, H.R., J.P. Madden, and P. Martin, A model to predict survival following liver retransplantation. Hepatology, 1999. 29(2): p. 365-370.
Facciuto, M., et al., Retransplantation for late liver graft failure: predictors of mortality. Liver Transplantation, 2000. 6(2): p. 174-179.
Torres-Quevedo, R., et al., Indications and results of liver retransplantation: experience with 1181 patients in the hospital universitario La Fe. Cirugía Española (English Edition), 2010. 87(6): p. 356-363.
Markmann, J.F., et al., Long-term survival after retransplantation of the liver. Annals of surgery, 1997. 226(4): p. 408.
- Abstract Viewed: 0 times