While liver transplantation has become increasingly successful over the last two decades, liver retransplantation shows significantly inferior results. The reasons for this include infections following surgery, multiorgan failure, bleeding complications, recurrence of the underlying disease, and chronic rejections.
Led by Robert Pfitzmann, M.D. of Charité Virchow Clinic in Berlin, Germany, researchers conducted a study of 119 retransplant recipients in their clinic between 1989 and 2003 in order to find ways of improving treatment and results. Analysis showed that coma, hemoglobin and the amount of plasma transfused during surgery were independent predictors of survival following retransplantation. In contrast to other studies, creatinine (a protein in the blood), the amount and time between the first and second transplant, donor and recipient age, ischemia time, bilirubin and hepatitis C status did not influence survival.
"These results support our assumption that the recipients' clinical status immediately before re-LT plays a very important role on the outcome of our patients, whereas the donor status appears less important" the authors note. At the same time, they acknowledge that they used "high quality standard selection criteria and acceptance of donor organs," which may explain why donor status was not predictive of outcome.
Their findings led to several therapeutic measures, including lowering the dosage of immunosuppressants very early, administering medication to improve kidney function, early blood transfusions, and continuous improvements in intensive care management. They note that patient survival after retransplant very strongly depends on the reason for the transplant, with patients experiencing Ischemic Type Biliary Lesions (ITBL) and rejection showing the best survival rates.
MEDICA.de; Source: John Wiley & Sons, Inc.