First series of Living Donor Liver Retransplants from India: Challenges and Outcomes

Abstract

BackgroundThere is paucity of Indian data on long term survival after living donor liver transplant (LDLT) or the need for retransplant. In this article, we report the first series of retransplants from India with focus on indications, technical challenges and results. MethodsRetrospective study on 29 patients undergoing a liver retransplant (re-LT) was analysed with respect to survival outcomes and post operative complications. Patients were divided into early and late retransplant groups based on whether re-LT was performed within or beyond 30 days of primary transplant. ResultsLiver retransplant was performed in 29 (0.81%) patients out of a total of 3563 liver transplants ( 28 living donor and 1 deceased donor liver transplant). The primary transplant was a LDLT in 27 (93%) patients. Retransplant was performed at a median of 26 days after the first transplant. Re-LT was performed early (within 30 days) in 17 (59%) patients and late (beyond 30 days) in 12 (41%). Hepatic artery thrombosis (53%) and early graft dysfunction (47%) were the indications for early retransplant while biliary complications (50%) and chronic rejection (33%) were primary indications for late retransplant. Post retransplant complications occurred in 22 (75%) patients, the commonest being gram negative bacterial sepsis.The 30-day mortality following retransplant was 27% (8 of 29). The primary cause of mortality was gram negative septicemia. The mortality in the late retransplant group (2, 16.6%) was lower compared to the early retransplant group (6,35%). ConclusionRe-transplant using living donors is a viable option in properly selected patients with prior LDLT.