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Hepatic retransplantation - An analysis of risk factors associated with outcome

Doyle, HR and Morelli, F and Mcmichael, J and Doria, C and Aldrighetti, L and Starzl, TE and Marino, IR (1996) Hepatic retransplantation - An analysis of risk factors associated with outcome. Transplantation, 61 (10). 1499 - 1505. ISSN 0041-1337

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Abstract

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 2.3), 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.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Doyle, HR
Morelli, F
Mcmichael, J
Doria, C
Aldrighetti, L
Starzl, TEtes11@pitt.eduTES11
Marino, IR
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 27 May 1996
Date Type: Publication
Journal or Publication Title: Transplantation
Volume: 61
Number: 10
Page Range: 1499 - 1505
DOI or Unique Handle: 10.1097/00007890-199605270-00016
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0041-1337
Other ID: uls-drl:31735062133560, Starzl CV No. 1891
Date Deposited: 08 Apr 2010 17:32
Last Modified: 25 Oct 2017 01:55
URI: http://d-scholarship.pitt.edu/id/eprint/5277

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