Hepatic retransplantation: University of Nebraska Medical Center experience

The lack of an artificial liver makes liver retransplantation a unique, life-saving procedure when all the other alternatives to save a failed graft have been exhausted. On the other hand, the shortage of donors in line with the increasing number of end-stage liver disease patients who are waiting in long recipient lists represents a dilemma and raises the question of most appropriate recipient selection. In this report, we retrospectively analyzed the results of 350 primary, 48 secondary, and 5 tertiary hepatic transplants performed between July 1985 and January 1990 at University of Nebraska Medical Center. The same immunosuppression protocol was used in each case and the maintenance immunosuppressive therapy consisted of cyclosporine (CyA) and steroids. The overall survival rate of 80.5% at 1 year which was achieved in the primary grafting group was significantly better than the secondary grafting group (63.0%, p < 0.05). However, this difference was not significant in pediatric patients and their survival rates were 73.8% and 71.6% in primary and secondary grafting groups, respectively. When the retransplanted patients were considered as deaths unless secondary grafting was performed, the overall patient survival rate of 69.7% in primary grafting group at 1 yr increased to 77.8% in the retransplanted group and this difference was significant (p < 0.05). Blood loss and operating time were found to be lower in the retransplanted group. Furthermore, the decrease of the operating time in the retransplanted pediatric patients reached statistical significance (p < 0.05). Retransplantation of the liver, when compared with primary grafting, was not associated with any further technical difficulties and in the light of our results appeared to be even less troublesome, particularly in early retransplants. In conclusion, we believe that retransplantation of the liver has a significant impetus on patient survival and there are firm grounds for optimism about its future.