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Brombosz EW, Moore LW, Mobley CM, Kodali S, Saharia A, Hobeika MJ, Connor AA, Victor DW, Cheah YL, Simon CJ, Gaber AO, Ghobrial RM. Factors affecting survival after liver retransplantation: a systematic review and meta-analysis. FRONTIERS IN TRANSPLANTATION 2023; 2:1181770. [PMID: 38993927 PMCID: PMC11235252 DOI: 10.3389/frtra.2023.1181770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/17/2023] [Indexed: 07/13/2024]
Abstract
Background Liver retransplantation (reLT) has historically had inferior survival relative to primary liver transplant (LT). To improve outcomes after reLT, researchers have identified factors predicting overall (OS) and/or graft survival (GS) after reLT. This systematic review and random effects meta-analysis sought to summarize this literature to elucidate the strongest independent predictors of post-reLT. Methods A systematic review was conducted to identify manuscripts reporting factors affecting survival in multivariable Cox proportional hazards analyses. Papers with overlapping cohorts were excluded. Results All 25 included studies were retrospective, and 15 (60%) were single-center studies. Patients on pre-transplant ventilation (HR, 3.11; 95% CI, 1.56-6.20; p = 0.001) and with high serum creatinine (HR, 1.46; 95% CI, 1.15-1.87; p = 0.002) had the highest mortality risk after reLT. Recipient age, Model for End-Stage Liver Disease score, donor age, and cold ischemia time >12 h also conferred a significant risk of post-reLT death (all p < 0.05). Factors affecting GS included donor age and retransplant interval (the time between LT and reLT; both p < 0.05). OS is significantly higher when the retransplant interval is ≤7 days relative to 8-30 days (p = 0.04). Conclusions The meta-analysis was complicated by papers utilizing non-standardized cut-off values to group variables, which made between-study comparisons difficult. However, it did identify 7 variables that significantly impact survival after reLT, which could stimulate future research into improving post-reLT outcomes.
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Affiliation(s)
| | - Linda W. Moore
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
- Department of Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Constance M. Mobley
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
- Department of Surgery, Weill Cornell Medical College, New York, NY, United States
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX, United States
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX, United States
| | - Sudha Kodali
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX, United States
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX, United States
- Department of Medicine, Weill Cornell Medical College, New York, NY, United States
| | - Ashish Saharia
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
- Department of Surgery, Weill Cornell Medical College, New York, NY, United States
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX, United States
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX, United States
| | - Mark J. Hobeika
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
- Department of Surgery, Weill Cornell Medical College, New York, NY, United States
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX, United States
| | - Ashton A. Connor
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
- Department of Surgery, Weill Cornell Medical College, New York, NY, United States
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX, United States
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX, United States
| | - David W. Victor
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX, United States
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX, United States
- Department of Medicine, Weill Cornell Medical College, New York, NY, United States
| | - Yee Lee Cheah
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX, United States
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX, United States
| | - Caroline J. Simon
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX, United States
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX, United States
| | - Ahmed Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
- Department of Surgery, Weill Cornell Medical College, New York, NY, United States
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX, United States
| | - Rafik Mark Ghobrial
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
- Department of Surgery, Weill Cornell Medical College, New York, NY, United States
- JC Walter Jr Transplant Center, Houston Methodist Hospital, Houston, TX, United States
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX, United States
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Kim SH, Kim YK. Emergency, ABO-Incompatible Living Donor Liver Re-Transplantation for Graft Failure Complicated by Pneumonia-Associated Sepsis. J Clin Med 2023; 12:jcm12031110. [PMID: 36769757 PMCID: PMC9917672 DOI: 10.3390/jcm12031110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Although liver re-transplantation is the only therapeutic option for acute and chronic graft failure, few studies have addressed the use of ABO-incompatible living donors in the emergency setting. Here, based on our experience, we report a successful case of emergency, ABO-incompatible, adult-to-adult, living donor liver re-transplantation (LDLT) for late graft failure from chronic rejection complicated by pneumonia-related sepsis. A fifty-five-year-old man had undergone LDLT for hepatocellular carcinoma accompanied by hepatitis C virus (HCV)-related cirrhosis in 30 September 2013. The voluntary donor was his 56-year-old wife, who was also a carrier of HCV. The donor and recipient blood types were the same: O and Rh positive. She underwent a right hepatectomy and was discharged on postoperative day (POD) seven. The patient was also discharged without complications on POD eleven and was followed up with on an outpatient basis. Abdominal distension and jaundice were developed at 6 months after LDLT, when the serum total bilirubin level was 2.7 mg/dL. The serum total bilirubin levels increased rapidly to 22.9 mg/dL over the next 4 months. Chronic rejection was diagnosed via liver biopsy. On 3 October 2014, he developed pneumonia-related sepsis and showed the progressive deterioration of liver function. Liver re-transplantation using the right liver from his ABO-incompatible, 20-year-old nephew was performed as an emergency in 15 October 2014. The donor blood type was A and Rh positive. The resection of the failed graft and the implantation of a new graft was performed by the intragraft dissection technique to re-use previously transplanted graft vessels in order to cope with severe adhesions. The recipient went through a gradual recovery process and was finally discharged on POD 50 with normal liver function, while the donor had an uneventful recovery and was discharged on POD 7. Biloma due to bile leak was detected three months after re-transplantation and was cured by percutaneous interventional procedures. Since then, the postoperative course has been event-free at regular outpatient follow-ups. The patient has so far had normal laboratory findings and no signs of complications. It has been 98 months since the re-transplantation, and the recipient and two donors are still in good condition with normal liver function, having complete satisfaction with the results obtained from this re-transplantation. In conclusion, long-term, satisfactory outcomes can be achieved in emergency, ABO-incompatible, adult-to-adult, living donor liver re-transplantation for graft failure complicated by pneumonia-related sepsis in selected patients.
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Affiliation(s)
- Seoung Hoon Kim
- Organ Transplantation Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si 10408, Republic of Korea
- Correspondence: ; Tel.: +82-31-920-1647; Fax: +82-31-920-2798
| | - Young-Kyu Kim
- Department of Surgery, Jeju National University School of Medicine, Aran 13gil 15 (Ara-1Dong), Jeju-si 63241, Republic of Korea
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Halle-Smith JM, Hall LA, Hann A, Hartog H, Perera MTPR, Neil DAH. Seventh Day Syndrome Revisited: Early Recognition of the Clinical Syndrome and an Evolving Understanding of Its Etiology. FRONTIERS IN TRANSPLANTATION 2022; 1:913584. [PMID: 38994381 PMCID: PMC11235295 DOI: 10.3389/frtra.2022.913584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/08/2022] [Indexed: 07/13/2024]
Abstract
Background Unexplained acute failure of an initially functioning liver graft early post-transplant has been described as Seventh-Day Syndrome (7DS). The aims of this study were to describe the clinical syndrome in detail based on an institutional case series and literature review. Methods A retrospective review of adult patients that underwent deceased donor liver transplantation at our institution between January 2010 and 2020 was performed to identify patients that developed 7DS. Relevant clinical variables were obtained from medical records. Existing cases in the literature were identified by a systematic literature search according to PRISMA guidelines. Pooled analysis was used to describe the incidence, retransplantation, and mortality rate. Histological findings from institutional and published literature cases were collected and appraised. Results Six of 1,907 liver transplantations at our institution (0.3%) developed 7DS. Seven case series, describing 42 patients with 7DS, and two single case reports were identified from literature review. Pooled incidence of 7DS was low (2.1%, 95%CI: 0.7-3.9%) and associated with high mortality (74.8%, 95%CI: 49.2-94.6%). Retransplantation was performed in 23/42 (55%) patients and 4/23 (17%) survived. Review of histology showed frequent intrahepatic thrombi and arteritis. Rejection, with features of potential antibody mediated rejection, often preceded or accompanied progressive zonal coagulative necrosis and hemorrhage. Conclusions 7DS is a rare clinical syndrome after liver transplantation and associated with high mortality. Antibody-mediated rejection, as suggested in early reports, is likely to be involved in the pathogenesis. Early recognition would allow rapid clinical diagnostics and expedited decisions, such as treatment of AMR if diagnosed or early retransplantation.
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Affiliation(s)
| | - Lewis A. Hall
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Angus Hann
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Hermien Hartog
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | | | - Desley A. H. Neil
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
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Li J, Guo QJ, Jiang WT, Zheng H, Shen ZY. Complex liver retransplantation to treat graft loss due to long-term biliary tract complication after liver transplantation: A case report. World J Clin Cases 2020; 8:568-576. [PMID: 32110668 PMCID: PMC7031839 DOI: 10.12998/wjcc.v8.i3.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/31/2019] [Accepted: 01/08/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Loss of graft function after liver transplantation (LT) inevitably requires liver retransplant. Retransplantation of the liver (ReLT) remains controversial because of inferior outcomes compared with the primary orthotopic LT (OLT). Meanwhile, if accompanied by vascular complications such as arterial and portal vein (PV) stenosis or thrombosis, it will increase difficulties of surgery. We hereby introduce our center's experience in ReLT through a complicated case of ReLT.
CASE SUMMARY We report a patient who suffered from hepatitis B-associated cirrhosis and underwent LT in December 2012. Early postoperative recovery was uneventful. Four months after LT, the patient’s bilirubin increased significantly and he was diagnosed with an ischemic-type biliary lesion caused by hepatic artery occlusion. The patient underwent percutaneous transhepatic cholangial drainage and repeatedly replaced intrahepatic biliary drainage tube regularly for 5 years. The patient developed progressive deterioration of liver function and underwent liver re-transplant in January 2019. The operation was performed in a classic OLT manner without venous bypass. Both the hepatic artery and PV were occluded and could not be used for anastomosis. The donor PV was anastomosed with the recipient’s left renal vein. The donor hepatic artery was connected to the recipient’s abdominal aorta. The bile duct reconstruction was performed in an end-to-end manner. The postoperative process was very uneventful and the patient was discharged 1 mo after retransplantation.
CONCLUSION With the development of surgical techniques, portal thrombosis and arterial occlusion are no longer contraindications for ReLT.
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Affiliation(s)
- Jiang Li
- Department of Liver Transplant, Tianjin First Central Hospital, Tianjin 300192, China
| | - Qing-Jun Guo
- Department of Liver Transplant, Tianjin First Central Hospital, Tianjin 300192, China
| | - Wen-Tao Jiang
- Department of Liver Transplant, Tianjin First Central Hospital, Tianjin 300192, China
| | - Hong Zheng
- Department of Liver Transplant, Tianjin First Central Hospital, Tianjin 300192, China
| | - Zhong-Yang Shen
- Department of Liver Transplant, Tianjin First Central Hospital, Tianjin 300192, China
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Equivalent Outcomes With Retransplantation and Primary Liver Transplantation in the Direct-acting Antiviral Era. Transplantation 2019; 103:1168-1174. [DOI: 10.1097/tp.0000000000002460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Stankiewicz R, Kornasiewicz O, Grąt M, Lewandowski Z, Gorski Z, Krawczyk M. Is Elective Status a Predictor of Poor Survival in Liver Retransplantation? Transplant Proc 2017; 49:1364-1368. [PMID: 28736008 DOI: 10.1016/j.transproceed.2017.01.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/06/2017] [Accepted: 01/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Orthotopic liver retransplantation (reLT) is considered to have poorer outcomes than primary transplantation. The objective of this study was to analyze the impact of medical urgency status as a predictor of patient survival after reLT. METHODS Forty-nine patients who underwent reLT were included in this retrospective study. Urgent or elective status was based on the judgment of the surgical team, selected variables, and the Model for End-Stage Liver Disease score. Multivariate analysis was performed to identify variables associated with patient survival following reLT. RESULTS Overall survival of the patient cohort was 57% at 1 year and 54.3% at 3 years after reTL. Survival in urgent-status patients was 68.8% and 63.4% at 1 and 3 years, respectively, whereas the survival rate for elective patients was 40.0% at both time points. Mortality was significantly associated with elective status (hazard ratio [HR], 2.42; P = .046) at 1 year, but was no longer significant (HR, 2.19; P < .069) after 3 years of follow-up. CONCLUSIONS Elective status is associated with poorer outcome. Patient selection determines long-term survival more than any other single factor, so for patients designated to an elective status, prompt retransplantation should be encouraged.
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Affiliation(s)
- R Stankiewicz
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
| | - O Kornasiewicz
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Grąt
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Z Lewandowski
- Department of Epidemiology, Medical University of Warsaw, Warsaw, Poland
| | - Z Gorski
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Krawczyk
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
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Abstract
Hepatic retransplantation has been surgically challenging since the beginning of liver transplant. Outcomes have improved over time, but patient survival with retransplant continues to be significantly worse than that of primary transplant. Many studies have focused on factors to predict outcomes. Models have been developed to help predict risk, but the decision for retransplant must be a multidisciplinary transplant team decision. The question of "when is too much?" can be guided by recipient and donor factors but is an ethical decision that must be made by the liver transplant team.
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Affiliation(s)
- Jennifer Berumen
- Department of Abdominal Transplantation and Hepatobiliary Surgery, University of California, San Diego, La Jolla, CA 92037, USA.
| | - Alan Hemming
- Department of Abdominal Transplantation and Hepatobiliary Surgery, University of California, San Diego, La Jolla, CA 92037, USA
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Dreyzin A, Lunz J, Venkat V, Martin L, Bond GJ, Soltys KA, Sindhi R, Mazariegos GV. Long-term outcomes and predictors in pediatric liver retransplantation. Pediatr Transplant 2015; 19:866-74. [PMID: 26362966 DOI: 10.1111/petr.12588] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 12/12/2022]
Abstract
Historically, 9-29% of pediatric liver transplant recipients have required retransplantation. Although outcomes have improved over the last decade, currently published patient and graft survival remain lower after retransplant than after primary transplant. Data from liver retransplantation recipients at our institution between 1991 and 2013 were retrospectively reviewed. Kaplan-Meier estimates were used to depict patient and graft survival. Predictors of survival were analyzed using a series of Cox proportional hazards models. Predictors were analyzed separately for patients who had "early" (≤ 30 days after primary transplant) and "late" retransplants. Eighty-four patients underwent retransplant at a median time of 241 days. Sixty percent had late retransplants. At one, five, and 10 yr, actuarial patient and graft survival were 73%/71%, 66%/63%, and 58%/53%, respectively. Since 2002, patient and graft survival improved to 86%/86% at one yr and 93%/87% at five yr. While operative complications were a common cause of death after earlier retransplants, since 2002, infection has been the only cause of death. Significant morbidities at five-yr follow-up include renal dysfunction (15%), diabetes (13%), hypertension (26%), chronic rejection (7%), and PTLD (2%). Current survival after pediatric liver retransplantation has improved significantly, but long-term immunosuppressant morbidity remains an opportunity for improvement.
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Affiliation(s)
| | - John Lunz
- Department of Pathology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Veena Venkat
- Division of Pediatric Gastroenterology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Lillian Martin
- Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Geoffrey J Bond
- Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kyle A Soltys
- Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rakesh Sindhi
- Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - George V Mazariegos
- Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Immordino G, Bottino G, De Negri A, Diviacco P, Moraglia E, Ferrari C, Picciotto A, Andorno E. Predictability and Survival in Liver Replantransplantation: Monocentric Experience. Transplant Proc 2014; 46:2290-2. [DOI: 10.1016/j.transproceed.2014.07.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Hepatic retransplant accounts for 5% to 15% of liver transplants in most series and is associated with significantly increased hospital costs and inferior patient survival when compared with primary liver transplant. Early retransplants are usually due to primary graft nonfunction or vascular thrombosis, whereas later retransplants are most commonly necessitated by chronic rejection or recurrent primary liver disease. Hepatic retransplant remains the sole option for survival in many patients facing allograft failure after liver transplant. With improved techniques to match retransplant candidates with appropriate donor grafts, it is hoped that the outcomes of retransplant will continue to improve in future.
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