The causes and outcomes analysis of liver re-transplantation

Abstract

Objective To analyze the causes and outcomes of liver re-transplantation and compare the relationship between different sources of donor liver and re-transplantation. Methods The clinical data of 1 429 liver transplantation recipients underwent liver transplantation between January 2000 and May 2018 in West China Hospital of Sichuan University were retrospectively analyzed. For the first liver transplantation, 686 cases of donor livers were from cadaveric donors, 346 cases were from donation after cardiac death (DCD) and 397 cases were from living donors. Thirty-one recipients received re-transplantation (32 cases, one received two times) and the rate of re-transplantation was 2.24% (32/1 429), among which 23 cases of donor livers were from cadaveric donors, 6 cases of donor livers were from DCD and 3 cases of donor livers were from living donors. The median interval time of re-transplantation was 311 d (88-845 d). Three recipients recieved re-transplantation from 1 to 7 days after the first transplantation, 1 recipients recieved re-transplantation from 8 to 30 days after the first transplantation, 15 recipients recieved re-transplantation from 31 to 365 days after the first transplantation and 13 recipients recieved re-transplantation 1 year later after the first transplantation. The Kaplan-Meier method was used to caculate the survival time of liver re-transplantation recipients and draw the survival curve. The suvival rate of 1-, 5- and 10-year of long time interval group (n=13, 1 year later after the first transplantation) and short time interval group (n=18, within 1 year after the first transplantation) were compared by the Breslow test. Fisher′s exact test was used to compare the re-transplantation rates of different sources of donor liver. Results Twelve recipients survived (38.7%) and 19 recipients died (61.3%) until May 2018. The median survival time was 17 months (2-102 months). The re-transplantation rates of cadaveric liver donor, DCD liver donor and living liver donor were 3.4% (23/686), 1.7% (6/346) and 0.8% (3/367), respectively. There was a significant difference in the re-transplantation rate between cadaveric donor liver and living donor liver (P=0.007), and there was no significant difference between DCD liver transplantation and other 2 types (cadaveric and living donor liver transplantation) (P=0.137 and 0.222). Among the 18 recipients in short time interval group, 6 recipients survived and 12 recipients died; for the left 13 liver re-transplantation recipients in long time interval group, 6 recipients survived and 7 recipients died. The 1-, 5- and 10-year overall survival rates of liver re-transplantation recipients were 64.2%, 51.2% and 46.6%. The 1-, 3-, 5-year overall survival rates of short time interval group and long time interval group were 49.4%/84.6%, 41.2%/65.8%, 30.9%/65.8%, respectively, which had no significant difference (χ2=2.946, P>0.05). Conclusions Re-transplantation is the only effective treatment for graft dysfunction after liver transplantation. The liver re-transplantation recipients are often in critical condition with high perioperative mortality after transplantation. Biliary complications and rejection are the main causes of re-transplantation. We should carefully grasp the timing of re-transplantation, and more studies are urgently needed. Key words: Liver transplantation; Re-transplantation; Survival time; Survival rate; Donation after cardiac death