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Long-term outcome of liver retransplantation in children

Deshpande, Rahul R.1; Rela, Mohamed1 2; Girlanda, Raffaele1; Bowles, Matthew J.1; Muiesan, Paolo1; Dhawan, Anil1; Mieli-Vergani, Giorgina1; Heaton, Nigel D.1

Clinical Transplantation

Background.  Retransplantation of the liver is the only means of prolonging survival in children whose initial graft has failed. Patient and graft survival rates after retransplantation in most series have been inferior to rates after first transplantation.

Patients and methods.  Of 450 pediatric liver transplantations performed between January1990 and March 2001, 50 were first retransplantations, 9 were second retransplantations, and 1 was a third retransplantation. The overall retransplantation rate was 13.3% (median age at retransplantation 4 years and median weight 15 kg). The median post-retransplantation follow-up was 73 (range, 6–139) months.

Results.  Kaplan-Meier patient survival rates for the group (n=50) were 71.7%, 64.7%, and 64.7% at 1, 3, and 5 years, respectively. Graft survival rates were 65.6%, 56.7%, and 56.7% at 1, 3, and 5 years, respectively. This is significantly worse than rates for children undergoing first liver transplantation. There were 17 deaths, of which 9 occurred in the first month. Biliary complications occurred in 5 (10%) patients and vascular complications in 6 (12%). Improved patient and graft survival rates were observed in the later phase of the program, although the difference was not significant. Higher preoperative serum creatinine (P =0.001) and serum bilirubin (P =0.02) levels were associated with a higher postoperative mortality.

Conclusion.  Results of retransplantation in children remain inferior to those after first transplantation. There is a trend toward improving results. Liver retransplantation makes an important contribution to overall survival in children.

1 Institute of Liver Studies, Kings College Hospital, Denmark Hill, London, UK.

2 Address correspondence to: M. Rela, M.D., Institute of Liver Studies, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK. E-mail:

Received 24 January 2002.

Revision Requested 12 April 2002.

Accepted 31 May 2002.

© 2002 Lippincott Williams & Wilkins, Inc.