Ischemic-type biliary lesions: A leading indication of liver retransplantation with excellent results - 03/04/19
, Pierre-Yves Boelle b, c, Fabiano Perdigao a, Denis Bernard d, Olivier Soubrane e, g, Filomena Conti b, fBienvenido a EM-consulte, la referencia de los profesionales de la salud.
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Highlights |
• | Background: liver retransplantation (RLT) is the only life-saving treatment option for patients with a failing graft, but it remains a major challenge because of inferior outcomes and technical difficulties. |
• | Methods: this study aimed to evaluate the outcomes of and risk factors for adult RLT in a single center, focusing on the etiology of graft failure. Between 1987 and 2011, 1592 liver transplants (LTs) and 143 RLTs (9%) were performed at our institution. |
• | Results: the 1-, 5- and 10-year patient survival rates after RLT were 60%, 52% and 39%, and the graft survival rates were 55%, 46% and 32%. The 90-day mortality rate was 32%, mainly due to septic complications (45% of deaths). Ischemic-type biliary lesions (ITBL) were the leading indication for RLT (23%), and patient survival was significantly better in patients retransplanted for ITBL than for any other indication (P<0.02). Indications other than ITBL (P=0.015), the transfusion of more than 7 units (P=0.006) and preoperative dialysis (P=0.005) were the three parameters associated with poor survival after RLT. |
• | Conclusion: patients with ITBL benefit the most from elective RLT. |
Summary |
Background |
Liver retransplantation (RLT) is the only life-saving treatment option for patients with a failing graft, but it remains a major challenge because of inferior outcomes and technical difficulties.
Methods |
This study aimed to evaluate the outcomes of and risk factors for adult RLT in a single center, focusing on the etiology of graft failure. Between 1987 and 2011, 1592 liver transplants (LTs) and 143 RLTs (9%) were performed at our institution.
Results |
The 1-, 5- and 10-year patient survival rates after RLT were 60%, 52% and 39%, and the graft survival rates were 55%, 46% and 32%. The 90-day mortality rate was 32%, mainly due to septic complications (45% of deaths). Ischemic-type biliary lesions (ITBL) were the leading indication for RLT (23%), and patient survival was significantly better in patients retransplanted for ITBL than for any other indication (P<0.02). Indications other than ITBL (P=0.015), the transfusion of more than 7 units (P=0.006) and preoperative dialysis (P=0.005) were the three parameters associated with poor survival after RLT.
Conclusion |
Patients with ITBL benefit the most from elective RLT.
El texto completo de este artículo está disponible en PDF.Keywords : Liver retransplantation, Ischemic-type biliary lesion, Performance status, Organ shortage
Abbreviations : LT, RLT, ITBL, PNF, HAT, CMV, MRI, ERCP, ICU
Esquema
Vol 43 - N° 2
P. 131-139 - avril 2019 Regresar al número
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Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
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Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
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