Retransplantation for Graft Failure More Than 5 Years after Primary Liver Transplant

Introduction: Graft failure is a much feared complication after liver transplantation, and retransplant is often indicated. Little is known about the outcome following retransplants which take place more than 5 years after the first. Methods: This is a retrospective study of liver retransplants performed by a single centre between 1996 and 2013; which the retransplant was performed more than 60 months after the first. The retransplants were divided into a deceased donor group (DD) and a living donor group (LD). We analyzed their perioperative parameters and survival outcomes. Results: There were 10 patients in the DD group and 6 patients in the LD group. Biliary complications, chronic rejection and recurrent hepatitis C infection were the main indications for retransplantation. The LD group had a significantly longer intensive care unit stay of 23 days compared with 4 days in the DD group (P = 0.004); also a longer hospital stay of 42 days compared with 18 days in the DD group (P = 0.034). The two groups had comparable preoperative MELD score, intraoperative blood loss, transfusion requirement, operating time and complication rate. There were 2 hospital mortalities in the DD group but none in the LD group. Patient survival at 5 years was 100% in the LD group and 80% in the DD group (P = 0.260). No patient in either group has died after discharge from hospital following retransplant. Conclusion: Long term survival is excellent after liver retransplantation when the retransplant takes place more than 5 years after the first.