RETRANSPLANTATION OF THE LIVER - A 7-YEAR EXPERIENCE

被引:96
作者
DALESSANDRO, AM [1 ]
PLOEG, RJ [1 ]
KNECHTLE, SJ [1 ]
PIRSCH, JD [1 ]
STEGALL, MD [1 ]
HOFFMANN, R [1 ]
SOLLINGER, HW [1 ]
BELZER, FO [1 ]
KALAYOGLU, M [1 ]
机构
[1] UNIV WISCONSIN,SCH MED,DEPT SURG,MADISON,WI 53792
关键词
D O I
10.1097/00007890-199305000-00028
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Three hundred and four patients underwent 362 liver transplants between July 1984 and April 1992. Fifty-eight retransplants were performed in 44 patients (14.5%). Thirty-four patients underwent two (77.3%), seven patients three (15.9%), two patients four (4.5%), and one patient five (2.3%) transplants. Poor function accounted for 23 retransplants (6.4%), technical problems for 19 retransplants (5.2%), and rejection for 15 retransplants (4.1%). One-month patient survivals after retransplantation for poor function, technical problems, or rejection were similar (79.0%, 73.4%, and 80.0%, respectively). No difference in retransplantation rates were seen between adults and children receiving whole liver transplants (WLT) (11.6% versus 19.1%). However, retransplantation for poor function was more common in pediatric recipients receiving reduced-size liver transplants (RLT) (20.0% versus 0.0%, P<0.01), while retransplantation for hepatic artery thrombosis (HAT) was more common in pediatric recipients receiving WLT (16.7% versus 2.8%, P<0.05). The presence of multiorgan system failure of greater than four was associated with a high mortality (90%), whereas patients undergoing emergent retransplantation who had less than four systems fail had a survival of 73.9% and patients who underwent elective retransplantation had a survival rate of 81.8%. Length of stay and cost of liver transplantation was higher in patients undergoing retransplantation when compared with primary transplants (29.7+/-14.9 days versus 58.4+/-38.9 days and $122,358+/-59,782 versus $289,302+/-126,907, P<0.01). The overall actuarial one-year patient survival in primary transplants was 86.6% and in retransplants 74.8%, and at five years these were 71.4% versus 62.5%, respectively (P<0.05). Our results support continued retransplantation of the liver unless the patient's medical condition dictates otherwise.
引用
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页码:1083 / 1087
页数:5
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