Hepatic Retransplantation--an analysis of risk factors associated with outcome.

Citation data:

Transplantation, ISSN: 0041-1337, Vol: 61, Issue: 10, Page: 1499-505

Publication Year:
1996
Usage 169
Downloads 167
Abstract Views 2
Captures 10
Readers 10
Citations 130
Citation Indexes 130
Repository URL:
http://d-scholarship.pitt.edu/id/eprint/5277
PMID:
8633379
DOI:
10.1097/00007890-199605270-00016
Pitt D-Scholarship Id:
5277
PMCID:
PMC2956444
Author(s):
HR Doyle; F Morelli; J McMichael; C Doria; L Aldrighetti; JJ Fung; TE Starzl; IR Marino
Publisher(s):
Ovid Technologies (Wolters Kluwer Health)
Tags:
Medicine
article description
Hepatic retransplantation is controversial because the results are inferior to primary transplants and organs are so scarce. To determine the factors that are associated with poor outcome within the first year following retransplantation, we performed a multivariate analysis, using stepwise logistic regression, of 418 hepatic retransplantations performed at a single institution from November 1987 to December 1993. The minimum follow-up was 1 year. Seven variables were found to be independently associated with subsequent graft failure (defined as either patient death or retransplantation): donor age (odds ratio 2.2 for each 10-year increase over age 45, 95% CI 1.3 to 3.7), female donor sex (odds ratio 1.7, 95% CI 1.05 to 2.7), recipient age (odds ratio 1.6 for each 10-year increase over age 45,95% CI 1.2 to 2.8), need for preoperative mechanical ventilation (odds ratio 1.8, 95% CI 1.1 to 2.9), pretransplant serum creatinine (odds ratio 1.24 for each increase of 1 mg/dl, 95% CI 1.1 to 1.4), pretransplant total serum bilirubin (odds ratio 1.4 for each 10-mg/dl increase over 15 mg/dl, 95% CI 1.1 to 1.8), and the primary immunosuppressant, using tacrolimus as the reference category (odds ratio for cyclosporine-based immunosuppression 3.9, 95% CI 2.3 to 6.8). Although not part of the logistic regression model, the timing of retransplantation was also found to be important, with the overall probability of failure increasing from 0.58 on day 0 to a peak of 0.8 on day 38 and decreasing slowly after that. The implications of these results regarding the appropriateness of retransplantation are discussed.