Introduction: Liver retransplantation is the main therapeutic option after an irreversible failure of the previous graft. Late liver retransplantation (LLR) have become a growing therapeutic need in pediatric population thanks to the significant increase in the survival of these kind of patients in the last decades. Technically highly complex, these procedures are considered to have a higher complication rate while patients are supposed to have worse survival rates. Our aim is to analyze the results of our pediatric LLR series by comparing it with our general series.
Materials and Methods: Retrospective analysis of our pediatric liver transplantation (LT) series. LLR cases where identified as those performed more than 6 months after the first transplant.
We performed a descriptive and comparative analysis between them and the general series considering demographic, technical, clinical and survival variables.
Results: There were 36 LLR [24 female (67%), 12 male (33%)] among the 751 LT of our general series (4.8%). LLR patients presented a significant higher age compared to the general series [8 years (0-20) vs 2 years (0-20)]. LLR were carried out after an average time of 52 months (6-207) after the previous transplant; 29 of them were second grafts, 6 thirds and 1 fourths. Among them, 12 were retransplanted more than 5 years after the first LT. No differences were found in the use of vascular grafts for vascular anastomoses (19% LLR VS 13% LT, p = 0.31) nor in the total duration of the procedure (8.5h LLR VS 7.8h LT, p = 0.66). There were no differences in the rates of acute rejection (8% LLR VS 20% LT, p = 0.09), biliary complications (11% LLR VS 7% LT, p = 0.28) or early vascular complications (11% LLR VS 6.8% LT, p = 0.27). The overall patient survival was slightly lower in the LLR group but with no statistically significant differences. Eleven of the 12 patients who received an LLR after more than 5 years since the previous LT are currently alive with a functioning graft.
Conclusions: LLR in pediatric patients has a similar prognosis compared to those patients with an only graft. This therapeutic option should be offered as an alternative for retransplanted patients with liver failure.