CRCM  Vol.2 No.9 , December 2013
Analysis of critical issues in case management for liver retransplantation
ABSTRACT

We report a case of a patient who underwent successful combined liver-kidney transplant after two prior liver transplantations. The topic of liver retransplantation is very controversial. Given the critical organ shortage, the question arises as to whether hepatic retransplantation should be offered liberally despite its greater cost, and inevitable denial of access to primary transplantation for the other patients on the waiting list. We suggest that careful selection of the retransplant candidates will improve outcomes and allow rational use of the limited organ supply. Analysis of the available literature allows us to identify the main predictors of morbidity and mortality for this patient population. It also enables development of a detailed plan for perioperative management. The role of transesophageal echocardiography (TEE) as a monitor in the complex liver transplant cases is also discussed. Our report is a significant contribution to the very limited data available on the subject of multiple liver retransplants.


Cite this paper
Moguilevitch, M. and Delpin, E. (2013) Analysis of critical issues in case management for liver retransplantation. Case Reports in Clinical Medicine, 2, 508-512. doi: 10.4236/crcm.2013.29133.
References
[1]   Azoulay, D., Linhares, M.M., Huguet, E., Delvart, V., Castaing, D. and Adam, R. (2002) Decision for retransplantationof liver: An experience and cost based analysis. Annals of Surgery, 236, 713-721.
http://dx.doi.org/10.1097/00000658-200212000-00003

[2]   Jain, A., Reyes, J., Kashyap, R., Dodson, S.F., Demetris, A.J., Ruppert, K., Abu-Elmaqd, K. and Gayowski, T. (2000) Long-term survival after liver transplantation in 4,000 consecutive patients at a single center. Annals of Surgery, 232, 490-500.
http://dx.doi.org/10.1097/00000658-200010000-00004

[3]   Kashyap, R., Jain, A., Reyes, J., Demetries, A.J., Elmagd, K.A. and Dodson, S.F. (2001) Causes of retransplantation after primary liver transplantation in 4000 consecutive patients: 2-19 years follow-up. Transplantation Proceedings, 33, 1486-1487.
http://dx.doi.org/10.1016/S0041-1345(00)02563-X

[4]   Bramhall, S.R., Minford, E., Gunson, B. and Buckels, J.A. (2001) Liver transplantation in the UK. World Journal of Gastroenterology, 7, 602-61

[5]   Pfitzmann, R., Benscheidt, B., Langrehr, J.M., Schumacher, G., Neuhaus, R. and Neusaus, P. (2007) Trends and experiences in liver transplantation over 15 years. Liver Transplantation, 13, 248-257.
http://dx.doi.org/10.1002/lt.20904

[6]   Markmann, J.F., Markowitz, J.S., Yersiz, H., Morrisey, M., Farmer, D.G. and Farmer, D.A. (1997) Long-term survival after retransplantation of the liver. Annals of Surgery, 226, 408-420.
http://dx.doi.org/10.1097/00000658-199710000-00002

[7]   Postma, R., Haagsma, E.B., Peeters, P.M., Van den Berg, A.P. and Slooff, M.J. (2004) Retransplantation of the liver in adults: outcome and predictive factors for survival. Transplant International, 17, 234-240.
http://dx.doi.org/10.1111/j.1432-2277.2004.tb00436.x

[8]   Enestvedt, C.K., Malik, S., Reese, P.P., Maskin, A., Yoo, P.S., Fayek, S.A., Abt, P., Olthoff, K.M. and Shaked, A. (2013) Biliary complications adversely affect patient and graft survival after liver retransplantation. Liver Transplantation, 19, 965-972.
http://dx.doi.org/10.1002/lt.23696

[9]   Bilbao, I., Figueras, J., Grande, L., Cleries, M., Jaurrieta, E., Visa, J. and Margarit, C. (2003) Risk factors for death following liver retransplantation. Transplantation Proceedings, 35, 1871-1873.
http://dx.doi.org/10.1016/S0041-1345(03)00585-2

[10]   Mora, N.P., Klintmalm, G.B., Cofer, J.B., Poplawski, S.S., Goldstein, R.M., Gonwa, T.A. and Husberg, B.S. (1990). Results after liver retransplantation (RETx): A comparative study between “elective” vs “non-elective” RETx. Transplantation Proceedings, 22, 1509-1511.

[11]   D’Alessandro, A.M., Ploeg, R.J., Knechtle, S.J., Pirsch, J.D., Stegall, M.D., Hoffman, R. and Sollinger, H.W. (1993) Retransplantation of the liver: A seven-year experience. Transplantation, 55, 1083-1087.
http://dx.doi.org/10.1097/00007890-199305000-00028

[12]   Bellido, C.B., Martinez, J.M.A., Gomez, L.M.M., Artacho, G.S., Diez-Canedo, J.S., Pulido, L.B., Acevedo, J.M.P. and Bravo, M.A.G. (2010) Indications for and Survival after liver retransplantation. Transplantation Proceedings, 42, 637-640.
http://dx.doi.org/10.1016/j.transproceed.2010.02.017

[13]   Magee, J.C., Barr, M.L., Basadonna, G.P., Johnson, M.R., Mahadevan, S., McBride, M.A., Schaubel, D.E. and Leichtman, A.B. (2007) Repeat organ transplantation in the United States, 1996-2005. American Journal of Transplatation, 7, 1424-1433.
http://dx.doi.org/10.1111/j.1600-6143.2007.01786.x

[14]   Biggins, S.W., Beldecos, A., Rabkin, S. and Rosen, H.R. (2002) Retransplantationfor hepatic allograft failure: Prognostic modeling and ethical consideration. Liver Transplantation, 8, 313-322.
http://dx.doi.org/10.1053/jlts.2002.31746

[15]   Linhares, M.M., Delcio, M., Adauto, C.F., Tarcisio, T., Alberto, G. and Denis, C. (2006) Liver retransplantation: A model for determining long-term survival. Transplantation, 81, 1016-1021.
http://dx.doi.org/10.1097/01.tp.0000203798.96491.2f

[16]   European Liver Transplant Registery. (2000)
http://www.eltr.org

[17]   Mirza, D.F., Gunson, B.K. and Da Silva, R.F. (1994) Policies in Europe on “marginal quality” donor livers. Lancet, 344, 1480-1483.
http://dx.doi.org/10.1016/S0140-6736(94)90294-1

[18]   Lerut, J.P., Bourlier, P. and de Ville de Goyet, J. (1995) Improvement of technique for adult orthotopic liver transplantation. Hepatology, 30, 395-400.

[19]   OPTN/SRTR 2010 Annual Report. (2010)
http://optn.transplant.hrsa.gov/ar2010

[20]   Wax, D.B., Torres, A., Scher, C. and Lebowitz, A.B. (2008) Transesophageal echocardiography utilization in high-volume liver transplant centers in the United States. Journal of Cardiothoracic and Vascular Anesthesia, 22, 811-813. http://dx.doi.org/10.1053/j.jvca.2008.07.007

[21]   Yoo, M.C., West, J.M., Eason, D. and Vanatta, J.M. (2012) The advantages and disadvantages of perioperative transesophageal echocardiography during liver transplantation. Anesthesia and Clinical Research, S4, 003.
doi:10.4172/2155-6148.S4-003.

[22]   Warnaar, N., Molenaar, I.Q., Colquhoun, S.D., Sloof, J.H., Sherwani, S., De Wolf, A.M. and Porte, R.J. (2007) Intraoperative pulmonary embolism and intracardiac thrombosis complicating liver transplantation: A systemic review. Journal of Thrombosis and Haemostasis, 6, 297-302.

[23]   Sakai, T., Matsusaki, T., Dai, F., Tanaka, K.A., Donaldson, J.B., Hilmi, I.A., Marsh, J.W., Planinsic, R.M. and Humar, A. (2012) Pulmonory thromboembolism during adult liver transplantation: incidence, clinical presentation, outcome, risk factors, and diagnostic predictors. British Journal of Anesthesia, 3, 469-477.
http://dx.doi.org/10.1093/bja/aer392

[24]   Spier, B.J., Larue, S., Teelin, T., Leff, J. and Swize, L.R. (2009) Review of complications in a series of patients with known gastro-esophageal varices undergoing transesophageal echocardiography. Journal of the American Society of Echocardiography, 22, 396-400.
http://dx.doi.org/10.1016/j.echo.2009.01.002

 
 
Top