Outcome of liver retransplantation in children

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Abstract
Irreversible liver graft failure is a life‐threatening complication. We reviewed the first 200 pediatric liver transplantations in Birmingham. Forty‐one children developed primary graft failure, 9 of whom developed secondary graft failure. The main indications for graft failure were primary nonfunction (PRNF; 8 patients), vascular complications (VASC; 23 patients), and chronic rejection (CHRE; 19 patients). Thirty‐two children underwent retransplantation (ReTx) (21 children received reduced grafts; 11 children, whole hepatic grafts). Patient survival was significantly worse for retransplant recipients compared with children receiving a single graft (63% v 76.5% actuarial patient survival at 1 year; P < .05). Primary graft 1‐year actuarial survival was 74% in first grafts compared with 47% for regrafts (P < .05), but improved with time. The graft 1‐year survival rate was 55% for whole grafts and 45% for reduced and/or split grafts in the first 100 grafts compared with 83% and 66% in the second 100 grafts, respectively (P < .01). Emergency ReTx within a month of transplantation was associated with more complications and a worse outcome (1‐year survival rate, 37%) compared with patients who underwent ReTx later (1‐year survival rate, 72%; P < .01). The incidence of primary graft failure decreased from 33% in the first 100 grafts to 16% in the second 100 grafts (P < .01), as did the incidence of PRNF, which decreased from 8% to 0% (P < .05). Although the rates of graft failure from VASC decreased from 15% to 8% (P = .2) and CHRE decreased from 11% to 8% (P = .6), neither reached statistical significance. The improved results overall are because of advances in surgical techniques, intensive care management, and graft preservation and refinements in immunosuppression. We conclude that ReTx for a child with primary graft failure is justified.