Retransplantation of the liver

Abstract

Since the introduction of cyclosporine-prednisone for primary immunosuppression, retransplantation has become a feasible option for patients whose primary grafts are failing, which may result from primary graft nonfunction, intractable rejection, or consequent to technical complications. Although survival of patients requiring second grafts is less good than in those whose initial graft functions well, 2-year survival rates of 49% have been achieved in retransplanted patients, a record that mandates serious consideration of this approach when the primary graft begins to fail. In general, the retransplant procedure is technically easier, with less blood loss, than is the initial operation. When the reoperation is done electively, it should be done before serious clinical deterioration compromises the chances for success.

FIG. 1. Liver transplants per calendar year

(Reproduced with permission from Shaw et al.)

FIG. 2. Liver retransplantation with cyclosporine and prednisone: primary disease categories

(Reproduced with permission from Shaw et al.)

FIG. 3. Indications for liver retransplantation: cyclosporine era

Primary nonfunction in patients, technical failure in 10, and rejection in 28. (Reproduced with permission from Shaw et al.)

FIG. 4. Indications for retransplantation

(Reproduced with permission from Shaw et al.)

FIG. 5. Actuarial survival after liver retransplantation; before and after the introduction of cyclosporine-prednisone therapy

(Reproduced with permission from Shaw et al.)

FIG. 6. Actuarial survival after liver retransplantation with cyclosporine and prednisone in pediatric and adult patients

(Reproduced with permission from Shaw et al.)

FIG. 7. Actuarial survival for liver transplantation, based on indication for graft replacement

(Reproduced with permission from Shaw et al.)

FIG. 8. Effect of liver retransplantation on actuarial survival

(Reproduced with permission from Shaw et al.)

FIG. 9. Intact upper caval anastomosis with short cuff of vein from the liver being removed, which is left in place for anastomosis with the new organ

(Reproduced with permission from Starzl.)