Retransplantation using living donor right liver graft

Abstract

Objectives: Retransplantation of the liver (ReLT) remains controversial because of the inferior outcomes compared with the primary liver transplantation (LT). Outcome data for retransplantation after living donor liver transplantation (LDLT) are rarely reported. We aimed to review the outcomes of patient who received ReLT using living donor right liver graft. Materials and Methods Retrospective study of a prospectively collected database of all liver transplant patients managed at the Department of Surgery, Queen Mary Hospital, Hong Kong was performed. Between August 1996 and July 2012, 32 patients received ReLT. 10 of them received right lobe LDLT (ReLT-LDLT group) and the remaining 22 patients received deceased donor liver transplantation (ReLT-DDLT group). The operative parameters and post-operative outcomes of these patients were analyzed. Results: The median pre-operative MELD score were 22 (10-38) and 23 (7-46) for the ReLT-LDLT group and ReLT-DDLT group respectively. 80% of ReLT-DDLT patients and 100% of ReLT-LDLT patients had retransplantation performed >30 days after primary LT. Vascular and biliary complications were the main indications for ReLT in both groups. In our cohort, ReLT-LDLT was associated with significantly younger donor (31 years old vs 48 years old, p=0.005), shorter cold ischaemic time (114 min vs 462.5 min, p<0.001) and more prolonged operation (922.5 min vs 699 min, p = 0.045). Early complications rate were up to 70% for ReLT-LDLT and 84% for ReLT-DDLT group (p=0.381). The one-, three- and five-years overall survival were all 88.9% for the ReLT-LDLT group and 77.3%, 72.7% and 61.5% for the ReLT-DDLT group (p=0.246). The one-, three- and five-years graft survival for the ReLT-LDLT group were all 88.9% and 72%, 64% and 54.2% for the ReLT-DDLT group (p=0.132). Conclusions: In this study, we showed that the long term outcome of patients after retransplanation using right liver graft was satisfactory, at the expense of considerable morbidities and re-interventions. LDLT was associated with better graft quality in terms of younger donor and shorter cold ischaemic time, which would potentially lead to better long term outcome.