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Abstract
We report a case of a patient who underwent successful combined liver-kidney transplant after two prior liver transplantations. The topic of liver retransplantation is very controversial. Given the critical organ shortage, the question arises as to whether hepatic retransplantation should be offered liberally despite its greater cost, and inevitable denial of access to primary transplantation for the other patients on the waiting list. We suggest that careful selection of the retransplant candidates will improve outcomes and allow rational use of the limited organ supply. Analysis of the available literature allows us to identify the main predictors of morbidity and mortality for this patient population. It also enables development of a detailed plan for perioperative management. The role of transesophageal echocardiography (TEE) as a monitor in the complex liver transplant cases is also discussed. Our report is a significant contribution to the very limited data available on the subject of multiple liver retransplants.
Highlights
Liver transplantation is currently the life-saving therapeutic modality for treatment of the end-stage liver disease
With significant advances in antiviral therapy, postoperative immunosuppression and improved surgical technique today’s 5 and 10 year survival rates after orthotopic liver transplant are over 70% and 65% respectively [1]
Transplantation is often the best option for patients faced with organ failure
Summary
Liver transplantation is currently the life-saving therapeutic modality for treatment of the end-stage liver disease. With significant advances in antiviral therapy, postoperative immunosuppression and improved surgical technique today’s 5 and 10 year survival rates after orthotopic liver transplant are over 70% and 65% respectively [1]. In an era of extreme organ shortage, the practice of liver retransplantation can deny access to transplantation to patients waiting for their first transplant. The annual death rate per 1000 patient has been 2 to 3 times higher for recipients of multiple liver procedures versus recipients of primary transplants over the past 9 years [8]. Careful selection of patients for retransplantation and especially for the repeated retransplantation is extremely important. The decision regarding this high-risk surgery should be individualized and based on specific patient risk factors and the chances for long-term survival
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