Key Operative Technique for Improvement of Liver Retransplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZANG Yunjin ,  WU Fengdong , SHEN Zhongyang

The Institute of Liver Transplantation， General Hospital of Chinese People’s Armed Police Forces， Beijing 100039， China;

Corresponding author：

WU Fengdong, Email: wufengdong19692@sina.com

Keywords：

Liver transplantation; Reoperation

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Objective 　To summary the operative technique of liver retransplantation （RLT）.
Methods 　The clinical data of 62 cases who had received RLT in our institute from Jan. 2003 to Jun. 2012 were analyzed retrospectively， and the experience about RLT was summaried too.
Results 　The operative time 〔（12.7±3.5） h vs. （10.5±3.0） h〕， bleeding volume （3 431 mL vs. 2 211 mL）， and blood volume transfused during operation （3 229 mL vs. 1 910 mL） in 62 cases who had underwent RLT were longer or higher than that of 38 patients who had underwent the first liver transplantation （LT） in our hospital （P＜0.05）， but there was no significant difference on the model for end-stage liver disease （MELD） score between the 2 groups （P＞0.05）. All cases were followed up for 1-104 months （average 31 months）. Twenty case died within 1 month after RLT， including sever lung or abdominal infection in 13 cases， multiple organ failure in 4 cases， hepatic artery complication in 2 cases， and portal vein complication in 1 case. Eight cases died of tumor recu-rrence during 14-69 months （average 27 months） after RLT. The cumulative survival rate of 1-， 2-， and 5-year of 62 cases of RLT were 67.7%， 59.7%， and 56.4%， respectively. The 34 patients had survived for 3-104 months （average 49 months）， of them， there were biliary stenosis in 3 cases who were cured by interventional radiology treatment， biliary stenosis in 2 cases who were cured by a third RLT， infection in 10 cases who were cured by anti-infective therapy and immunosuppressant adjustment， light rejection in 2 cases who were relieved by dosage increase of oral immunosuppressant， other 17 cases suffered no complications and all in good condition.
Conclusions 　RLT is an effective method for irreversible graft failure after LT. Proper surgical procedure contributes to the increase of survival rate of patients who has received RLT.

Citation： ZANG Yunjin,WU Fengdong,SHEN Zhongyang. Key Operative Technique for Improvement of Liver Retransplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(3): 241-245. doi: Copy

1.	Marudanayagam R， Shanmugam V， Sandhu B， et al. Liver retransplantation in adults：a single-centre， 25-year experience[J]. HPB (Oxford)， 2010， 12(3)：217-224.
2.	Crivellin C， De Martin E， Germani G， et al. Risk factors in liverretransplantation：a single-center experience[J]. Transplant Proc， 2011， 43(4)：1110-1113.
3.	Watt KD， Lyden ER， Mccashland TM. Poor survival after liver retransplantation：is hepatitis C to blame?[J]. Liver Transpl， 2003， 9(10)：1019-1024.
4.	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.
5.	Torres-Quevedo R， Moya-Herraiz A， San Juan F， et al. Indications and results of liver retransplantation：experience with 1 181 patients at the University Hospital La Fe[J]. Cir Esp， 2010， 87(6)：356-363.
6.	Reese PP， Yeh H， Thomasson AM， et al. Transplant center volume and outcomes after liver retransplantation[J]. Am J Transplant， 2009， 9(2)：309-317.
7.	Remiszewski P， Kalinowski P， Dudek K， et al. Influence of selected factors on survival after liver retransplantation[J]. Transplant Proc， 2011， 43(8)：3025-3028.
8.	Benson AB， Burton JR Jr， Austin GL， et al. Differential effects of plasma and red blood cell transfusions on acute lung injury and infection risk following liver transplantation[J]. Liver Transpl， 2011， 17(2)：149-158.
9.	Yang SC， Chen CL， Wang CH， et al. Intraoperative blood and fluid administration differences in primary liver transplantation versus liver retransplantation[J]. Acta Anaesthesiol Taiwan， 2011， 49(2)：50-53.
10.	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. Marudanayagam R， Shanmugam V， Sandhu B， et al. Liver retransplantation in adults：a single-centre， 25-year experience[J]. HPB (Oxford)， 2010， 12(3)：217-224.
2. Crivellin C， De Martin E， Germani G， et al. Risk factors in liverretransplantation：a single-center experience[J]. Transplant Proc， 2011， 43(4)：1110-1113.
3. Watt KD， Lyden ER， Mccashland TM. Poor survival after liver retransplantation：is hepatitis C to blame?[J]. Liver Transpl， 2003， 9(10)：1019-1024.
4. 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.
5. Torres-Quevedo R， Moya-Herraiz A， San Juan F， et al. Indications and results of liver retransplantation：experience with 1 181 patients at the University Hospital La Fe[J]. Cir Esp， 2010， 87(6)：356-363.
6. Reese PP， Yeh H， Thomasson AM， et al. Transplant center volume and outcomes after liver retransplantation[J]. Am J Transplant， 2009， 9(2)：309-317.
7. Remiszewski P， Kalinowski P， Dudek K， et al. Influence of selected factors on survival after liver retransplantation[J]. Transplant Proc， 2011， 43(8)：3025-3028.
8. Benson AB， Burton JR Jr， Austin GL， et al. Differential effects of plasma and red blood cell transfusions on acute lung injury and infection risk following liver transplantation[J]. Liver Transpl， 2011， 17(2)：149-158.
9. Yang SC， Chen CL， Wang CH， et al. Intraoperative blood and fluid administration differences in primary liver transplantation versus liver retransplantation[J]. Acta Anaesthesiol Taiwan， 2011， 49(2)：50-53.
10. 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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Key Operative Technique for Improvement of Liver Retransplantation

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