Predictors of retransplantation in liver transplant

Abstract

Introduction: A small subgroup of patients undergoing liver transplantation (LT) require retransplantation (RT), which is correlated with significantly higher morbidity, lower survival rates and increased medical costs. The purpose of the study is to determine the predictive factors of RT, following LT, clinical and laboratory findings were studied during the period from 2013 till 2016, effectuated by a medical team from Republican Clinical Hospital. Materials and Methods: Liver transplant evidence was sourced from the National Transplantation Agency database starting with February 1st, 2013, to March 20th, 2016. Covariates selected from the database for inclusion in the analysis admitted: recipient’s age, cold and warm ischemia time, donor’s type (cadaveric versus living), body mass index (BMI), model for end-stage liver disease (MELD) score at transplant, albumin level at transplant, gender of the recipient and transplant year. Recipient hepatitis C virus (HCV) and hepatocellular carcinoma (HCC) status were determined by using United Network for Organ Sharing (UNOS)/Organ Procurement and Transplantation Network (OPTN) primary diagnosis coding. Generalized linear modeling was used to determine the odds ratios (ORs) for the risk of RT in liver transplant recipients. According to National Transplantation Agency of Republic of Moldova since 2013 were registered 212 potential brain death donors, but families of 99 (46,69 %) of them have refused donation.Conclusion: Our analysis identified several host and graft-related predictors of RT in liver transplant recipients. Efforts must be directed to reduce the significant number of RT in the era of donor shortage and ever increasing demand for LT. Both, the community and physicians should therefore approach organ transplant positively and objectively and treat ethical, social and religious issues as negotiable perspectives and not barriers to organ transplant.