The only option for patients with a failing allograft is retransplantation.
Living donor liver transplantation is a well-accepted therapeutic option for end-stage liver disease. However, retransplantation from a living donor has not previously been discussed.
In this study, 547 living donor liver transplantations were performed in 519 children at Kyoto University Hospital, Japan, between 1990 and 2002.
During this study period, 28 retransplantations were performed in 27 recipients.
The research team evaluated patient survival in relation several preoperative factors. These included functional status, pretransplantation apheresis, cause of primary graft failure, interval from primary to subsequent transplants, and laboratory values of total bilirubin and creatinine.
They found that the retransplantation survival rate at 1 year was 48%.
They also determined that functional status, pretransplantation apheresis, interval to retransplantation, and bilirubin and creatinine levels all had an adverse impact on survival.
The researchers found that the major causes of primary graft failure were chronic rejection, chronic cholangitis, and vascular complications. Of these, vascular complications had the greatest adverse impact on survival.
Dr Ogura's team concluded, "Living donor liver retransplantation can save patients with a failing allograft".
"To achieve better results after retransplantation, further investigations are necessary to understand the factors leading to poor outcome".