Trends and experiences in liver retransplantation over 15 years

Compared to primary liver transplantation (LT), the inferior results in the outcome of liver retransplantation (re-LT) continue to be a major challenge. The purpose of this study was to analyze changes in and outcomes of re-LT over a period of 15 years at the Charite Virchow Clinic. Between 1989 and 2003, we performed 1,619 LTs and 157 re-LTs (9.7%) in 1,462 patients. A total of 119 retransplants (50 females, 69 males) were analyzed after consideration of exclusion criteria: recipient age <16 years, second re-LT, primary LT as split-liver or living-related LT, or combination with renal transplantation or Whipple operation. All patients received a whole-size organ. Mean follow-up was 62 months (6 days to 187 months). The main indications for re-LT were initial nonfunction (26.9%), recurrence of viral-induced hepatitis (20.2%), or acute and chronic rejection or thrombosis of the hepatic artery (both 16.8%). The main causes of death were bacterial infections (26.0%) as well as bleeding complications or recurrence of disease (both 16.0%) within the first postoperative month. Overall, 50 out of 119 patients (42%) died after re-LT, 26 patients within the first 3 months and 38 within 1 year. Overall patient survival was 89.9% after 1 month, 78.2% after 1 year, and 67.1% after 5 years. In conclusion, our study showed good clinical results after re-LT. Apart from the changing indications for re-LT with an increasing amount of initial organ failure and hepatic artery thrombosis, the analysis also showed a decreasing amount of complications such as rejection, ischemic type biliary lesions, and recurrence of the disease with unchanged outcome over a period of 15 years.