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Hepatic retransplantation in cholestatic liver disease: Impact of the interval to retransplantation on survival and resource utilization

Kim, WR and Wiesner, RH and Poterucha, JJ and Therneau, TM and Malinchoc, M and Benson, JT and Crippin, JS and Klintmalm, GBG and Rakela, J and Starzl, TE and Krom, RAF and Evans, RW and Dickson, ER (1999) Hepatic retransplantation in cholestatic liver disease: Impact of the interval to retransplantation on survival and resource utilization. Hepatology, 30 (2). 395 - 400. ISSN 0270-9139

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Abstract

The aim of our study was to quantitatively assess the impact of hepatic retransplantation on patient and graft survival and resource utilization. We studied patients undergoing hepatic retransplantation among 447 transplant recipients with primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) at 3 transplantation centers. Cox proportional hazards regression analysis was used for survival analysis. Measures of resource utilization included the duration of hospitalization, length of stay in the intensive care unit, and the duration of transplantation surgery. Forty-six (10.3%) patients received 2 or more grafts during the follow-up period (median, 2.8 years). Patients who underwent retransplantation had a 3.8-fold increase in the risk of death compared with those without retransplantation (P < .01). Retransplantation after an interval of greater than 30 days from the primary graft was associated with a 6.7-fold increase in the risk of death (P < .01). The survival following retransplantations performed 30 days or earlier was similar to primary transplantations. Resource utilization was higher in patients who underwent multiple consecutive transplantations, even after adjustment for the number of grafts during the hospitalization. Among cholestatic liver disease patients, poor survival following hepatic retransplantation is attributed to late retransplantations, namely those performed more than 30 days after the initial transplantation. While efforts must be made to improve the outcome following retransplantation, a more critical evaluation may be warranted for late retransplantation candidates.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Kim, WR
Wiesner, RH
Poterucha, JJ
Therneau, TM
Malinchoc, M
Benson, JT
Crippin, JS
Klintmalm, GBG
Rakela, J
Starzl, TEtes11@pitt.eduTES11
Krom, RAF
Evans, RW
Dickson, ER
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 9 August 1999
Date Type: Publication
Journal or Publication Title: Hepatology
Volume: 30
Number: 2
Page Range: 395 - 400
DOI or Unique Handle: 10.1002/hep.510300210
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0270-9139
Other ID: uls-drl:31735062120013, Starzl CV No. 2094
Date Deposited: 08 Apr 2010 17:35
Last Modified: 02 Feb 2019 13:56
URI: http://d-scholarship.pitt.edu/id/eprint/5480

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