This study was undertaken in an attempt to determine prognostic factors for children requiring hepatic retransplantation. The records of 315 children (age <15 yrs) who underwent 432 orthotopic liver transplants (OLT) at our institution between October 1984 and December 1995 were reviewed to determine the incidence and outcome of hepatic retransplantation. The median age for children undergoing OLT was 1.6 yrs. (range 0.03 to 15 yrs). Survival rates are shown as the Kaplan-Meier actuarial values at 1 year. Results Retransplantation for hepatic allograft failure was performed in 86 of the 315 OLT recipients (27.3%). Of these 86 patients, 60 (70.0%) required a single retransplant, 21(24.4%) underwent two retransplants, 4 (4.7%) underwent three retransplants, and 1 (1.2%) underwent four retransplants. No correlation was found between patient age at the first OLT and the incidence of retransplantation. The patient and graft survival for all first transplants (N=315) was 77.7% and 66.6% and for all patients undergoing retransplantation (N=86) was 53.8% and 43.1% (shown below). Patient and graft survival were similar for patients undergoing 1, 2, or 3 retransplants (patient survival 54%, 52%, and 60%; graft survival 42%, 48%, and 30% respectively). The interval between the first transplant and retransplantation was not predictive of patient or graft survival. There was a trend toward improved survival in patients retransplanted for vascular thrombosis (64.7%) or PNF (62.3%) as compared to patients retransplanted for rejection (33.5%) (p=NS). Children less than 3 years of age at the time of retransplantation had a significantly worse survival than did older children (44.5% vs 67.5%, p<0.05). In comparing the early period (1984-1990) to the recent period (1991-1995) it was found that the incidence of retransplantation decreased (33.2% vs 22.5%); patient survival increased slightly (50.0% vs 57.6%, p=NS). Conclusions 1. One half of pediatric patients with failed liver grafts can be rescued by aggressive retransplantation. 2. Survival was negatively affected by retransplantation before 3 years of age but not by the number of prior transplants. Based on these observations, we believe that an aggressive policy of retransplantation is warranted for children with failed liver grafts.
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