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Junger H, Knoppke B, Schurr L, Brennfleck FW, Grothues D, Melter M, Geissler EK, Schlitt HJ, Brunner SM, Goetz M. Good outcomes after repeated pediatric liver retransplantations: A justified procedure even in times of organ shortage. Pediatr Transplant 2024; 28:e14699. [PMID: 38433343 DOI: 10.1111/petr.14699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Pediatric liver transplantations generally represent advanced surgery for selected patients. In case of acute or chronic graft failure, biliary or vessel complications, a retransplantation (reLT) can be necessary. In these situations massive adhesions, critical patient condition or lack of good vessels for anastomosis often are problematic. METHODS Between 2008 and 2021, 208 pediatric patients received a liver transplantation at our center. Retrospectively, all cases with at least one retransplantation were identified and stored in a database. Indication, intra- and postoperative course and overall survival (OS) were analyzed. RESULTS Altogether 31 patients (14.9%) received a reLT. In 22 cases only one reLT was done, 8 patients received 2 reLTs and 1 patient needed a fourth graft. Median age for primary transplantation, first, second and third reLT was 14 (range: 1-192 months), 60.5 (range: 1-215 months), 58.5 (range: 14-131 months) and 67 months, respectively. Although biliary atresia (42%) and acute liver failure (23%) represented the main indications for the primary liver transplantation, acute and chronic graft failure (1st reLT: 36%, 2nd reLT: 38%), hepatic artery thrombosis (1st reLT: 29%, 2nd reLT: 25%, 3rd reLT: 100%) and biliary complications (1st reLT: 26%, 2nd reLT: 37%) were the most frequent indications for reLT. OS was 81.8% for patients with 1 reLT, 87.5% with 2 reLTs and 100% with 3 reLTs. CONCLUSION Pediatric liver retransplantation is possible with a good outcome even after multiple retransplantations in specialized centers. Nevertheless, careful patient and graft selection, as well as good preoperative conditioning, are essential.
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Affiliation(s)
- Henrik Junger
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Birgit Knoppke
- University Children's Hospital Regensburg (KUNO), University Medical Center Regensburg, Regensburg, Germany
| | - Leonhard Schurr
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Frank W Brennfleck
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
- Department of Surgery, Helios Klinikum Meiningen, Meiningen, Germany
| | - Dirk Grothues
- University Children's Hospital Regensburg (KUNO), University Medical Center Regensburg, Regensburg, Germany
| | - Michael Melter
- University Children's Hospital Regensburg (KUNO), University Medical Center Regensburg, Regensburg, Germany
| | - Edward K Geissler
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Hans J Schlitt
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Stefan M Brunner
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Markus Goetz
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
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Schaefer SL, Jabour SM, Englesbe M, Sonnenday CJ, Anderson MS. Incidence and outcomes of liver retransplantation using living donor allografts in the US. Liver Transpl 2023; 29:555-558. [PMID: 36747347 PMCID: PMC10134743 DOI: 10.1097/lvt.0000000000000085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/09/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Sara L. Schaefer
- Section of Transplantation, Department of Surgery, Michigan Medicine, Ann Arbor, MI
| | - Sarah M. Jabour
- Department of Surgery, Johns Hopkins Medicine, Baltimore, MD
| | - Michael Englesbe
- Section of Transplantation, Department of Surgery, Michigan Medicine, Ann Arbor, MI
| | | | - Maia S. Anderson
- Section of Transplantation, Department of Surgery, Michigan Medicine, Ann Arbor, MI
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Batra RK, Mulligan DC. Clinical and Ethical Framework for Liver Retransplantation Using Living Donor Grafts: A Western Perspective. Liver Transpl 2022; 28:760-762. [PMID: 34931433 DOI: 10.1002/lt.26395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Ramesh K Batra
- Department of Surgery (Transplant), Yale University School of Medicine/Yale New Haven Hospital, New Haven, CT
| | - David C Mulligan
- Department of Surgery (Transplant), Yale University School of Medicine/Yale New Haven Hospital, New Haven, CT
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Patel MS, Ghanekar A, Sayed BA, Sapisochin G, McGilvray I, Raschzok N, Reichman T, Selzner M, Galvin Z, Bhat M, Stunguris J, Ng VL, Lilly L, Selzner N, Cattral MS. Liver Retransplantation Using Living Donor Grafts: A Western Experience. Liver Transpl 2022; 28:887-890. [PMID: 34597461 DOI: 10.1002/lt.26314] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/10/2021] [Accepted: 09/08/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Madhukar S Patel
- Multi Organ Transplant Program, Ajmera Family Transplant Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anand Ghanekar
- Multi Organ Transplant Program, Ajmera Family Transplant Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Blayne Amir Sayed
- Multi Organ Transplant Program, Ajmera Family Transplant Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gonzalo Sapisochin
- Multi Organ Transplant Program, Ajmera Family Transplant Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ian McGilvray
- Multi Organ Transplant Program, Ajmera Family Transplant Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nathanael Raschzok
- Multi Organ Transplant Program, Ajmera Family Transplant Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Trevor Reichman
- Multi Organ Transplant Program, Ajmera Family Transplant Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Markus Selzner
- Multi Organ Transplant Program, Ajmera Family Transplant Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Zita Galvin
- Multi Organ Transplant Program, Ajmera Family Transplant Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mamatha Bhat
- Multi Organ Transplant Program, Ajmera Family Transplant Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jennifer Stunguris
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Vicky L Ng
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Les Lilly
- Multi Organ Transplant Program, Ajmera Family Transplant Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nazia Selzner
- Multi Organ Transplant Program, Ajmera Family Transplant Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mark S Cattral
- Multi Organ Transplant Program, Ajmera Family Transplant Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
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Zakaria H, Saleh Y, Zidan A, Sturdevant M, Alabbad S, Elsheikh Y, Al-Hamoudi W, Albenmousa A, Troisi RI, Broering D. Is It Justified to Use Liver Grafts From Living Donors for Retransplant? A Single-Center Experience. EXP CLIN TRANSPLANT 2019; 18:188-195. [PMID: 31875463 DOI: 10.6002/ect.2019.0262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Liver retransplant is considered the only hope for patients with irreversible graft failure after primary transplant. In most Western centers, retransplantis done mainly from deceased donors; so far, only few published studies have reported on outcomes of liver retransplant with living donors. In this study, our aim was to analyze the outcomes of living-donor liver retransplant. MATERIALS AND METHODS Patients who underwent liver retransplant between February 2011 and February 2019 were included in the study. Preoperative, operative, and postoperative data were analyzed. Results from 2 patient groups were compared: liver retransplant with living donors and liver retransplant with deceased donors. RESULTS Thirty-two patients underwent liver retransplant (21 adult and 11 pediatric patients). The most common indications for liver retransplant were hepatic artery thrombosis (28.5%) and primary graft nonfunction (23.8%) in adults and hepatic artery thrombosis (45.5%) and chronic rejection (36.4%) in pediatric patients. Seventeen retransplant patients (53.1%) required early retransplant (within 1 mo), mainly due to hepatic artery thrombosis (52.9%) and primary graft nonfunction (35.3%). Late retransplant was mainly due to chronic rejection (40%) and recurrence of primary disease (26.7%). Seventeen patients (53.1%) underwent living-donor retransplant, and 5 donors underwent robotic right hepatectomy. Graft and patient survival rates at 1, 3, and 5 years were 81.3% for living-donor and 51.4% for deceased-donor liver retransplant recipients (P = .08). On multivariate analyses, we observed significant differences between both groups in pretransplant Model for End-Stage Liver Disease and Pediatric End-Stage Liver Disease scores (P = .05), preoperative international normalized ratio (P = .012), and cold ischemia time (P = .046). CONCLUSIONS The use of living donors for liver retransplant, despite its technical demand, was shown to be a safe and feasible option, especially when there is scarcity of deceased donors.
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Affiliation(s)
- Hazem Zakaria
- >From the Department of Hepatopancreatobiliary and Liver Transplant Surgery, National Liver Institute, Menoufia University, Egypt; and the Department of Liver and Small Bowel Transplantation & HPB Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Choe J, Mulligan DC. Liver retransplantation: Recurrent primary sclerosing cholangitis may provide better outcomes. Liver Transpl 2017; 23:730-732. [PMID: 28425147 DOI: 10.1002/lt.24777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 04/17/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Jennie Choe
- Section of Transplantation and Immunology, Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT
| | - David C Mulligan
- Section of Transplantation and Immunology, Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT
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Abstract
Living donor liver transplantation (LDLT) nowadays represents an important and safe alternative to conventional deceased donor liver transplantation (DDLT). A major concern related to the LDLT procedure is still represented by donor safety because a serious operation not without risks must be carried out on a healthy individual. In the present review of the indications for LDLT the technical concepts of donor surgery, criteria for donor selection and evaluation and morbidity and mortality results related to the procedure are presented. In general, the indications for LDLT are almost the same as for DDLT. The donor hepatectomy (right, left or left lateral) is presented in five main phases. The reported morbidity rates vary between 10 % and 60 % and are strongly related to the experience of the transplant center. The currently reported postoperative mortality rates for left and right hepatectomy are 0.1 % and 0.5 %, respectively. The results of LDLT are similar if not even better than those for DDLT depending on the specific indications.
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