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Liver retransplantation in adult recipients: analysis of a 38‐year experience in the Netherlands
Author(s) -
Takagi Kosei,
Domagala Piotr,
Porte Robert J.,
Alwayn Ian,
Metselaar Herold J.,
den Berg Aad P.,
Hoek Bart,
Ijzermans Jan N. M.,
Polak Wojciech G.
Publication year - 2020
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.701
Subject(s) - medicine , liver transplantation , gastroenterology , surgery , transplantation
Background Liver retransplantation (re‐LT) accounts for up to 22% after primary liver transplantation (LT), and using donor livers for retransplantation can only be justified by successful outcomes. Methods A total of 2,387 adult recipients with 2,778 LT, between 1979 and 2017, were analyzed to determine risk factors and outcome of re‐LT in the Netherlands. Results Of 2,778 LT, 336 (12.1%) were first, 43 (1.5%) were second, and 12 (0.5%) were third or fourth re‐LT. The 5‐year patient survival for primary LT, and first, second, and third or fourth re‐LT were 74.0%, 70.8%, 63.3%, and 57.1%, respectively ( P = 0.10). Recipient age (≤60 years) (OR 1.96, P < 0.001), era (1979–2006) (OR 1.56, P = 0.003), donor after circulatory death (DCD) (OR 1.96, P < 0.001), and cold ischemia time (CIT) (>9 h) (OR 1.42, P = 0.007) were significant risk factors for retransplantation after primary LT. Conclusions Recipient age, era, DCD, and prolonged CIT were identified as parameters for retransplantation. The outcome after the first re‐LT was good, and comparable to those of primary transplants. Survival after multiple re‐LT was not significantly different from the first retransplant group, legitimizing third and fourth re‐LT to well‐selected patients.