Comparable short and long term outcomes in deceased and living donor liver retransplantation

Abstract

Background: Most studies of liver retransplantation were published more than a decade ago. Those published recently all have their focus on deceased donor liver retransplantation (re-DDLT). Living donor liver retransplantation re-LDLT remains an untouched topic. To determine if re-LDLT is a justifiable alternative to re-DDLT. Methods: Liver retransplantation recipients were divided into the reDDLT and re-LDLT groups. The groups were compared in terms of demographic characteristics, pre-retransplant and intraoperative details, and short- and long-term outcomes. Risk for living donors was examined. Result: Twenty-nine patients had a total of 33 re-DDLTs and 15 patients received re-LDLT. The re-LDLT group had significantly lighter grafts (median, 525 vs. 1295 g, p B 0.001), smaller ratio of graft weight to estimated standard liver volume (median, 56.98 vs. 107.7%, p B 0.001), shorter cold ischemia (median, 106 vs. 451 min, p B 0.001), and lower international normalized ratio on postoperative day 14 (median, 1.1 vs. 1.15, p = 0.013). The groups were otherwise comparable. Grade-5 complication occurred to two patients in the reDDLT group. The groups were similar in patient survival (p = 0.326) and graft survival (p = 0.102). No living donors died, but three (20%) of them developed grade-1 complications. Conclusion: With the required expertise, re-LDLT can produce satisfactory results which are comparable to those of re-DDLT while keeping the donor risk at bay. In places where the demand for deceased donor liver grafts far outstrips supply, re-LDLT can be considered as an alternative to re-DDLT if the expertise is available and if the potential recipient benefits can balance out the potential donor risks.