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Clinics and Research in Hepatology and Gastroenterology
Volume 43, n° 2
pages 131-139 (avril 2019)
Doi : 10.1016/j.clinre.2017.11.005
Liver and biliary diseases

Ischemic-type biliary lesions: A leading indication of liver retransplantation with excellent results
 

Astrid Schielke a, Olivier Scatton a, b, , Pierre-Yves Boelle b, c, Fabiano Perdigao a, Denis Bernard d, Olivier Soubrane e, g, Filomena Conti b, f
a Service de chirurgie digestive et transplantation hépatique, hôpital Pitié-Salpêtrière, AP–HP, 47–83, boulevard de l’Hôpital, 75013 Paris, France 
b Sorbonne Universités, UPMC université Paris 06, 4, place Jussieu, 75005 Paris, France 
c Department of Public Health, Hôpital Saint-Antoine, AP–HP, 184, rue du faubourg Saint-Antoine, 75012 Paris, France 
d Department of Anesthesiology, hôpital Pitié-Salpêtrière, AP–HP, 47–83, boulevard de l’Hôpital, 75013 Paris, France 
e Service de chirurgie digestive et transplantation hépatique, hôpital Beaujon, AP–HP, 100, boulevard du Général Leclerc, 92110 Clichy, France 
f Unité de transplantation hépatique, hôpital Pitié-Salpêtrière, AP–HP, 47–83, boulevard de l’Hôpital, 75013 Paris, France 
g Université Paris 07, 5, rue Thomas-Mann, 75013 Paris, France 

Corresponding author. Service de chirurgie digestive et transplantation hépatique, hôpital Pitié-Salpêtrière, Assistance publique–hôpitaux de Paris (AP–HP), 47–83, boulevard de l’Hôpital, 75651 Paris cedex 13, France.Service de chirurgie digestive et transplantation hépatique, hôpital Pitié-Salpêtrière, Assistance publique–hôpitaux de Paris (AP–HP)47–83, boulevard de l’HôpitalParis cedex 1375651France
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.

The full text of this article is available in PDF format.
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.

The full text of this article is available in PDF format.

Keywords : Liver retransplantation, Ischemic-type biliary lesion, Performance status, Organ shortage

Abbreviations : LT, RLT, ITBL, PNF, HAT, CMV, MRI, ERCP, ICU




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