Skip to main content
SpringerLink
Log in

Effects of Graft Quality on Non-Urgent Liver Retransplantation Survival: Should We Avoid High-Risk Donors?

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Few studies have studied the effects of graft quality on non-urgent liver retransplantation (ReLT) outcomes. We aimed to analyze graft characteristics and survival in non-urgent ReLT and the effect of using grafts with extended criteria on survival.

Methods

Eighty non-urgent ReLT were performed from June 1988 to June 2010. The whole series was divided by identical time periods to study time-related effects. We assessed graft quality with donor risk index (DRI) and Briceño scores and recipient status with the Model for End-stage Liver Diseases and Rosen scores. Low and high-risk grafts were defined by a DRI cutoff of 1.8.

Results

Graft survival was similar in both periods (1-, 5-, and 10-year graft survivals: 73.5, 46.9, and 40.8 versus 71, 47.7, and 47.7%, p = 0.935) although donor quality was worse in the second period (DRI: 1.35 ± 0.32 vs. 1.66 ± 0.34, p < 0.001). In the first period high-risk grafts did worse than low-risk grafts (5-year survival: 0 vs. 54.5%, p = 0.002) while in the second period outcomes were similar (5-year survival: 48.6 vs. 56.7 %, p = 0.660). Donor age was the only independent donor factor for graft survival, with lower survival when using grafts from donors over 60-years-old.

Conclusions

Graft quality in ReLT has worsened with time mainly because of older donors but nowadays the use of high-risk grafts in non-urgent ReLT is not associated with worse graft survival because of better perioperative management. Moreover of being selective on recipient conditions, care should be taken when using grafts from donors over 60-years-old for non-urgent ReLT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Anonymous (2011) United Network for Organ Sharing Transplantation. www.unos.org/. Accessed 12 June 2011

  2. Memoria de Resultados del Registro Español de Trasplante Hepático (1984–2002). www.ont.es. Accessed 12 June 2011

  3. Markmann JF, Markowitz JS, Yersiz H et al (1997) Long-term survival after retransplantation of the liver. Ann Surg 226:408–418

    Article  PubMed  CAS  Google Scholar 

  4. Lladó L, Castellote J, Figueras J (2005) Is retransplantation an option for recurrent hepatitis C cirrhosis after liver transplantation? J Hepatol 42:468–472

    Article  PubMed  Google Scholar 

  5. Wall WJ (1997) Recurrent disease after liver transplantation: implications for the future. Liver Transpl Surg 6:362–367

    Google Scholar 

  6. Margarit C (2005) Retrasplante hepático. Med Clin (Barc) 124:733–734

    Article  Google Scholar 

  7. Zimmermann MA, Ghobrial RM (2005) When shouldn’t we retransplant? Liver Transpl 11:S14–S20

    Article  Google Scholar 

  8. Ghobrial RM (2007) Changing faces of liver retransplantation: it is all about selection. Liver Transpl 13:188–189

    Article  PubMed  Google Scholar 

  9. Feng S, Goodrich NP, Bragg-Gresham JL et al (2006) Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transpl 6:783–790

    Article  CAS  Google Scholar 

  10. Tector AJ, Mangus RS, Chestovich P et al (2006) Use of extended criteria livers decreases wait time for liver transplantation without adversely impacting post transplant survival. Ann Surg 244:439–450

    PubMed  Google Scholar 

  11. Northup PG, Pruett TL, Kashmer DM et al (2007) Donor factors predicting recipient survival after liver retransplantation: the retransplant donor risk index. Am J Transpl 7:1984–1988

    Article  CAS  Google Scholar 

  12. Schmitt TM, Pruett TL, Kashmer D et al (2007) Liver retransplantation for hepatitis C: do extended criteria donors affect outcome? Liver Transpl 13(Suppl 1):443

    Google Scholar 

  13. Martí J, Charco R, Ferrer J et al (2008) Optimization of liver grafts in liver retransplantation: a European single-center experience. Surgery 144:762–769

    Article  PubMed  Google Scholar 

  14. Wiesner R, Edwards E, Freeman R et al (2003) Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 124:91–96

    Article  PubMed  Google Scholar 

  15. Rosen HR, Prieto M, Casanovas-Taltavull T et al (2003) Validation and refinement of survival models for liver retransplantation. Hepatology 38:460–469

    Article  PubMed  Google Scholar 

  16. Briceño J, Solorzano G, Pera C (2000) A proposal for scoring marginal liver grafts. Transpl Int 13:S249–S252

    Article  PubMed  Google Scholar 

  17. Amador A, Charco R, Marti J et al (2005) One thousand liver transplants: the Hospital Clinic experience. Transpl Proc 37:3916–3918

    Article  CAS  Google Scholar 

  18. Rosen HR, Madden JP, Martin P (1999) A model to predict survival following hepatic retransplantation. Hepatology 29:365–370

    Article  PubMed  CAS  Google Scholar 

  19. Azoulay D, Linhares MM, Huguet E et al (2002) Decision for retransplantation of the liver: an experience- and cost-based analysis. Ann Surg 236:713–721

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Liver Surgery and Transplantation Unit, Institut de Malalties Digestives i Metabòliques, IDIBAPS, Hospital Clínic i Provincial, CIBERehd, University of Barcelona, Villarroel, 170, 08036, Barcelona, Spain

    Josep Marti, Josep Fuster, Miquel Navasa, Joana Ferrer, Antoni Rimola, Amalia Pelegrina, Constantino Fondevila & Juan Carlos Garcia-Valdecasas

Authors
  1. Josep Marti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Josep Fuster
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miquel Navasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joana Ferrer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antoni Rimola
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Amalia Pelegrina
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Constantino Fondevila
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Juan Carlos Garcia-Valdecasas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Josep Fuster.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marti, J., Fuster, J., Navasa, M. et al. Effects of Graft Quality on Non-Urgent Liver Retransplantation Survival: Should We Avoid High-Risk Donors?. World J Surg 36, 2914–2922 (2012). https://doi.org/10.1007/s00268-012-1757-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-012-1757-z

Keywords

Search

Navigation