Actual outcomes and technical feasibility of living donor-related liver re-transplantation

Abstract

Introduction: The aim of this study was to analyze the experience of liver re-transplantation (re-LT) at a large volume living donor liver transplantation (LDLT) center and reviewed the technical feasibility of LDLT related re-LT. Methods: Adult (≥18 years) patients who underwent liver transplantation (LT) more than twice between February 1994 and December 2015 were included. The retrospective study was conducted based on the review of medical record. Results: Among 4,666 adult LTs including 3,843 LDLTs and 697 deceased donors LTs (DDLT), 126 cases (2.8%) were re-LTs. The mean age and MELD score was 53.3 ± 9.4 years and 25.7 ± 8.1, respectively. The mean interval from primary LT to re-LT was 28.8 ± 45.0 months. The overall 1-, 5- and 10-year survival rates of re-LT were 58.8%, 53.4% and 50.4%, respectively which were significantly lower than those of primary LT (p < 0.001). In multivariate analysis, re-LT timing, portal vein thrombosis, MELD score >20, bacteremia and pneumonia were independent risk factors for survival. Out of 126 re-LTs, 16 cases (12.7%) were re-LDLTs. In re-LDLTs, interposition graft for PV reconstruction was used in 2 cases. For hepatic artery anastomosis, right gastroepiploic artery was used in 2 cases and greater saphenous vein interposition was employed in 2 cases. The patient's survival rate of re-LDLT was significantly lower than that of primary LDLT (p < 0.001) and comparable to that of re-DDLT (p = 0.724). Conclusions: Re-LDLT can be the feasible option for the irreversible graft dysfunction to overcome the donor scarcity despite technical demand.