Retransplantation of the liver in adults: outcome and predictive factors for survival

Hepatic retransplantation is considered to carry a higher risk than primary transplantation. Survival might improve with more experience and better immunosuppression. We studied all 55 patients who were adults at the time of their first retransplantation and who underwent retransplantation between 1979 and May 2001. Patient survival at 1, 5 and 10 years was 73%, 63%, and 63%, respectively. Multivariate analysis of pre-transplant variables revealed prothrombin time, creatinine level, and indication for retransplantation, as independent predictive factors. Survival was highest in patients who had undergone retransplantation for hepatic artery thrombosis. Multivariate analysis, including pre-, per-, and post-operative variables, showed that era of transplantation, prothrombin time, blood loss, and intensive care unit (ICU) stay, were independent predictive factors. Survival at 1 and 5 years improved from 56% and 48%, respectively, before 1996 to 89% and 81%, respectively, after 1996. In conclusion, survival after hepatic retransplantation improved significantly through the years. Independent pre-transplant predictive factors were prothrombin time, creatinine level, and indication for retransplantation.