J Korean Surg Soc.  2003 Jun;64(6):493-497.

Liver Retransplantation: The AMC Experience

Affiliations
  • 1Department of Surgery, Hallym University College of Medicine, Seoul, Korea.
  • 2Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea. sunhyung@chollian.net

Abstract

PURPOSE
Although there has been recent progress in surgical techniques, such as perioperative management, immunosuppresive regimen and intervention radiology, a liver retransplantation remains as the only therapeutic option for patients with a failing liver allograft. The purpose of this study was to review our clinical experiences of liver retransplantation, performed at the Asan Medical Center. METHODS: Between August 1992 and March 2001, 400 cases of liver transplantations, including 331 in adults and 69 in pediatrics, were performed. Of the 331 adult cases, 10 cases of liver retransplantation, during the same period, were retrospectively analyzed. RESULTS: In the 331 cases of adult liver transplantation, 232 cases of living donor and 99 of cadaveric liver transplantations were carried out. The 331 adult cases also included 10 liver retransplantations. Therefore, the overall liver retransplantation rate was 3%. Primary non-function (PNF) was the leading cause of retransplantation. The conversion of living donor liver transplantation to a cadaveric liver retransplantation was the most common type of retransplantaion, with a cadaveric to cadaveric type the second most common. The in-hospital mortality was 40%. The causes of in-hospital mortality were hepatic artery pseudoaneurysm rupture, Aspergillus pneumonia, and multiple organ failure, initiated by jejuno-jejunostomy site bleeding and massive hepatic necrosis. CONCLUSION: In the current era of extreme organ shortage, retransplantation is the only therapeutic alternative for irreVersible graft failure, especially if the patient has no multiple organ failure (MOF) prior to the operation. Therefore, the careful selection of patients for a retransplantation is required. They should be given superurgent priority if the circumstances permit, and living donor liver transplantation (LDLT) offer a promising alternative.

Keyword

Liver retransplantation; Living donor liver transplantation (LDLT)

MeSH Terms

Adult
Allografts
Aneurysm, False
Aspergillus
Cadaver
Chungcheongnam-do
Hemorrhage
Hepatic Artery
Hospital Mortality
Humans
Liver Transplantation
Liver*
Living Donors
Massive Hepatic Necrosis
Multiple Organ Failure
Pediatrics
Pneumonia
Retrospective Studies
Rupture
Transplants
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