Analysis on Causes and Prognosis of Liver Retransplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HU Zhijun , ZHANG Haiming ,  SHEN Zhongyang , SUN Liying , ZHENG Hong , PAN Cheng , DENG Yonglin , LIU Yihe

Transplantation Department， Tianjin First Central Hospital， Tianjin 300192， China;

Corresponding author：

SHEN Zhongyang, Email: zhongyangshen@vip.sina.cn

Keywords：

Liver retransplantation; Graft survival; Graft failure; Complication

Video：

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Objective 　To explore the causes and prognosis of liver retransplantation.
Methods 　The clinical data of 215 cases who had underwent liver retransplantation in Tianjin First Central Hospital between Nov. 26th 2003 and May. 26th 2012 were analyzed retrospectively for its causes and prognosis.
Results 　Two hundreds and fifteen cases were enrolled， including 200 cases of 2 times liver transplantation， 14 cases of 3 times liver transplantation， and 1 case of 4 times liver transplantation. The major causes of the second liver transplantation were biliary complication （53.5%， 115/215） and primary non-function or dysfunction of liver graft （8.4%， 18/215）， and the major causes of the third liver transplantation were biliary complication （5/14） and hepatocellular carcinoma recurrence （2/14）. The liver graft survival rate of late liver retransplantation （at least 1 month after operation） was significantly higher than that of early liver retrans-plantation （less than 1 month after operation） for the second liver transplantation （P=0.005）. The liver graft survival rate of the second liver transplantation was significantly higher than that of the third liver transplantation （P=0.043）. Compared with biliary complication， cases of hepatocellular carcinoma recurrence （P=0.001） and primary non-function or dysfunction of liver graft （P=0.033） had lower graft survival rates， while cases of chronic failure of liver graft had a higher survival rate （P=0.037）.
Conclusions 　Biliary complication is the main cause of liver retransplantation. The liver retransplantations which are performed less than 1 month after prior liver transplantation result in a relative low survival rate in reason of the increase of perioperative death. The prognosis of liver retransplantation for hepatocellular carcinoma recurrence is unacceptable， while cases of chronic failure of liver graft have optimal prognosis.

Citation： HU Zhijun,ZHANG Haiming,SHEN Zhongyang,SUN Liying,ZHENG Hong,PAN Cheng,DENG Yonglin,LIU Yihe. Analysis on Causes and Prognosis of Liver Retransplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(3): 235-240. doi: Copy

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3.	Marudanayagam R， Shanmugam V， Sandhu B， et al. Liver retra-nsplantation in adults：a single-centre， 25-year experience[J]. HPB (Oxford)， 2010， 12(3)：217-224.
4.	Thuluvath PJ， Guidinger MK， Fung JJ， et al. Liver transplantation in the United States， 1999-2008[J]. Am J Transplant， 2010， 10(4 Pt 2)：1003-1019.
5.	沈中阳，朱志军，邓永林，等. 再次肝移植80例临床报告[J]. 中华外科杂志， 2006， 44(5)：298-301.
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7.	张建军，朱志军，郑虹，等. 再次肝移植132例的临床分析[J]. 中华器官移植杂志， 2009， 30(8)：477-479.
8.	张雅敏，朱志军，郑虹，等. 再次肝移植预后影响因素分析[J]. 中华肝胆外科杂志， 2008， 14(6)：361-363.
9.	Crivellin C， De Martin E， Germani G， et al. Risk factors in liver retransplantation：a single-center experience[J]. Transplant Proc， 2011， 43(4)：1110-1113.
10.	Remiszewski P， Kalinowski P， Dudek K， et al. Influence ofselected factors on survival after liver retransplantation[J]. Transplant Proc， 2011， 43(8)：3025-3028.
11.	Leithead JA， Smith MR， Materacki LB， et al. Intercurrent infectionpredicts mortality in patients with late hepatic artery thrombosislisted for liver retransplantation[J]. Liver Transpl， 2012， 18(11)：1353-1360.
12.	Zimmerman M， Ghobrial RM. When shouldn’t we retransplant?[J]. Liver Transpl， 2005， 11 Suppl 2：S14-S20.
13.	Hong JC， Kaldas FM， Kositamongkol P， 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[J]. Ann Surg， 2011， 254(3)：444-448.
14.	Markmann JF， Markowitz JS， Yersiz H， et al. Long-term survivalafter retransplantation of the liver[J]. Ann Surg， 1997， 226(4)：408-418.
15.	Azoulay D， Linhares MM， Huguet E， et al. Decision for retrans-plantation of the liver：an experience- and cost-based analysis[J]. Ann Surg， 2002， 236(6)：713-721.
16.	Maggi U， Andorno E， Rossi G， et al. Liver retransplantation in adults：the largest multicenter Italian study[J]. PLoS One， 2012， 7(10)：e46643.
17.	Bellido CB， Martínez JM， Artacho GS， et al. Have we changed the liver retransplantation survival?[J]. Transplant Proc， 2012， 44(6)：1526-1529.
18.	Shen ZY， Zhu ZJ， Deng YL， et al. Liver retransplantation：report of 80 cases and review of literature[J]. Hepatobiliary Pancreat Dis Int， 2006， 5(2)：180-184.
19.	Zarrinpar A， Hong JC. What is the prognosis after retransplantation of the liver?[J]. Adv Surg， 2012， 46：87-100.
20.	Herrmann J， Herden U， Ganschow R， et al. Transcapsular arterialneovascularization of liver transplants increases the risk of intrao-perative bleeding during retransplantation[J]. Transpl Int， 2013.[Epub ahead of print].
21.	Chen GH， Fu BS， Cai CJ， et al. A single-center experience of retransplantation for liver transplant recipients with a failing graft[J]. Transplant Proc， 2008， 40(5)：1485-1487.
22.	沈中阳，朱志军，郑虹，等. 再次肝移植临床分析[J]. 中华外科杂志， 2007， 45(5)：313-315.
23.	Chen GH， Fu BS， Yang Y， et al. Early liver retransplantation versus late liver retransplantation：analysis of a single-centerexperience[J]. Chin Med J (Engl)， 2008， 121(20)：1992-1996.
24.	朱志军，蔡金贞，饶伟，等. 再次肝移植治疗肝移植术后缺血型胆道狭窄的研究：附48例报告[J]. 中华肝胆外科杂志， 2007， 13(7)：445-448.
25.	Sibulesky L， Heckman MG， Perry DK， et al. A single-centerexperience with biliary reconstruction in retransplantation：duct-to-duct or Roux-en-Y choledochojejunostomy[J]. Liver Transpl， 2011， 17(6)：710-716.

1. Mehrabi A， Fonouni H， Müller SA， et al. Current concepts in transplant surgery：liver transplantation today[J]. Langenbecks Arch Surg， 2008， 393(3)：245-260.
2. Abbasoglu O. Liver transplantation：yesterday， today and tomorrow[J]. World J Gastroenterol， 2008， 14(20)：3117-3122.
3. Marudanayagam R， Shanmugam V， Sandhu B， et al. Liver retra-nsplantation in adults：a single-centre， 25-year experience[J]. HPB (Oxford)， 2010， 12(3)：217-224.
4. Thuluvath PJ， Guidinger MK， Fung JJ， et al. Liver transplantation in the United States， 1999-2008[J]. Am J Transplant， 2010， 10(4 Pt 2)：1003-1019.
5. 沈中阳，朱志军，邓永林，等. 再次肝移植80例临床报告[J]. 中华外科杂志， 2006， 44(5)：298-301.
6. 张雅敏，蔡金贞，朱志军，等. 再次肝移植的免疫抑制方案应用[J]. 广东医学， 2006， 27(7)：1085-1087.
7. 张建军，朱志军，郑虹，等. 再次肝移植132例的临床分析[J]. 中华器官移植杂志， 2009， 30(8)：477-479.
8. 张雅敏，朱志军，郑虹，等. 再次肝移植预后影响因素分析[J]. 中华肝胆外科杂志， 2008， 14(6)：361-363.
9. Crivellin C， De Martin E， Germani G， et al. Risk factors in liver retransplantation：a single-center experience[J]. Transplant Proc， 2011， 43(4)：1110-1113.
10. Remiszewski P， Kalinowski P， Dudek K， et al. Influence ofselected factors on survival after liver retransplantation[J]. Transplant Proc， 2011， 43(8)：3025-3028.
11. Leithead JA， Smith MR， Materacki LB， et al. Intercurrent infectionpredicts mortality in patients with late hepatic artery thrombosislisted for liver retransplantation[J]. Liver Transpl， 2012， 18(11)：1353-1360.
12. Zimmerman M， Ghobrial RM. When shouldn’t we retransplant?[J]. Liver Transpl， 2005， 11 Suppl 2：S14-S20.
13. Hong JC， Kaldas FM， Kositamongkol P， 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[J]. Ann Surg， 2011， 254(3)：444-448.
14. Markmann JF， Markowitz JS， Yersiz H， et al. Long-term survivalafter retransplantation of the liver[J]. Ann Surg， 1997， 226(4)：408-418.
15. Azoulay D， Linhares MM， Huguet E， et al. Decision for retrans-plantation of the liver：an experience- and cost-based analysis[J]. Ann Surg， 2002， 236(6)：713-721.
16. Maggi U， Andorno E， Rossi G， et al. Liver retransplantation in adults：the largest multicenter Italian study[J]. PLoS One， 2012， 7(10)：e46643.
17. Bellido CB， Martínez JM， Artacho GS， et al. Have we changed the liver retransplantation survival?[J]. Transplant Proc， 2012， 44(6)：1526-1529.
18. Shen ZY， Zhu ZJ， Deng YL， et al. Liver retransplantation：report of 80 cases and review of literature[J]. Hepatobiliary Pancreat Dis Int， 2006， 5(2)：180-184.
19. Zarrinpar A， Hong JC. What is the prognosis after retransplantation of the liver?[J]. Adv Surg， 2012， 46：87-100.
20. Herrmann J， Herden U， Ganschow R， et al. Transcapsular arterialneovascularization of liver transplants increases the risk of intrao-perative bleeding during retransplantation[J]. Transpl Int， 2013.[Epub ahead of print].
21. Chen GH， Fu BS， Cai CJ， et al. A single-center experience of retransplantation for liver transplant recipients with a failing graft[J]. Transplant Proc， 2008， 40(5)：1485-1487.
22. 沈中阳，朱志军，郑虹，等. 再次肝移植临床分析[J]. 中华外科杂志， 2007， 45(5)：313-315.
23. Chen GH， Fu BS， Yang Y， et al. Early liver retransplantation versus late liver retransplantation：analysis of a single-centerexperience[J]. Chin Med J (Engl)， 2008， 121(20)：1992-1996.
24. 朱志军，蔡金贞，饶伟，等. 再次肝移植治疗肝移植术后缺血型胆道狭窄的研究：附48例报告[J]. 中华肝胆外科杂志， 2007， 13(7)：445-448.
25. Sibulesky L， Heckman MG， Perry DK， et al. A single-centerexperience with biliary reconstruction in retransplantation：duct-to-duct or Roux-en-Y choledochojejunostomy[J]. Liver Transpl， 2011， 17(6)：710-716.

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Analysis on Causes and Prognosis of Liver Retransplantation

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