Should we perform deceased donor liver transplantation after living donor liver transplantation has failed?

Abstract

2011 AASLD.Received February 16, 2011; accepted April 27, 2011.By asking whether we should perform deceased donorliver transplantation (DDLT) after living donor livertransplantation (LDLT) has failed, we appear to bequestioning the generally accepted current practice ofretransplantation for transplant failure. However, wewill also consider in this analysis that LDLT may havebeen performed for patients whose tumors werebeyond the local criteria for listing or increased prior-ity on the deceased donor (DD) wait list (ie, thepatients were not eligible for DDLT originally). Toarrive at a recommendation, we will analyze the out-comes and ethical implications of retransplantationby considering the following 4 questions:1. Should we perform DDLT after the failure ofDDLT?2. Should we perform DDLT after the failure ofLDLT in a patient without hepatocellular carci-noma (HCC)?3. Should we perform DDLT after the failure ofLDLT in a patient with HCC who fulfills the localcriteria for listing and increased priority on thewait list?4. Should we perform DDLT after the failure ofLDLT in a patient with HCC who does not fulfillthe local criteria for listing or increased priorityon the wait list (ie, the patient failed to meet thecriteria for DDLT originally)?With questions 1 to 3, we will consider the ethicalfoundation for the current practice of retransplanta-tion for graft failure, and this discussion will serve asthe basis for question 4, which is more controversial.