Agarwal Shaleen, Dey Rajesh, Saigal Sanjiv, Nekarakanti Phani K, Gupta Subash
Centre for Liver and Biliary Sciences, Max Superspeciality Hospital, Saket, Delhi, India.
Centre for Liver and Biliary Sciences, Max Superspeciality Hospital, Vaishali, UP, India.
J Clin Exp Hepatol. 2025 Mar-Apr;15(2):102454. doi: 10.1016/j.jceh.2024.102454. Epub 2024 Nov 10.
There is a paucity of Indian data on long-term survival after living donor liver transplant (LDLT) or the need for retransplant (re-LT). In this article, we report the first series of retransplants from India with focus on indications, technical challenges and results.
A retrospective study on 29 patients undergoing a liver retransplant (re-LT) was analysed with respect to survival outcomes and postoperative complications. Patients were divided into early and late retransplant groups based on whether re-LT was performed within or beyond 30 days of primary transplant.
Liver retransplant was performed in 29 (0.81%) patients out of a total of 3563 liver transplants (28 living donor and one deceased donor liver transplant). The primary transplant was an LDLT in 27 (93%) patients. Retransplant was performed at a median of 26 days after the first transplant. Re-LT was performed early (within 30 days) in 17 (59%) patients and late (beyond 30 days) in 12 (41%). Hepatic artery thrombosis (53%) and early graft dysfunction (47%) were the indications for early retransplant, while biliary complications (50%) and chronic rejection (33%) were primary indications for late retransplant. Postretransplant complications occurred in 22 (75%) patients, the commonest being gram-negative bacterial sepsis. The 30-day mortality after retransplant was 27% (8/29). The primary cause of mortality was gram-negative septicaemia. The mortality in the late retransplant group (2, 16.6%) was lower than in the early retransplant group (6, 35%).
Retransplant using living donors is a viable option in properly selected patients with prior LDLT.
关于活体肝移植（LDLT）后长期生存或再次移植（re-LT）需求，印度的数据匮乏。在本文中，我们报告了印度首批再次移植病例系列，重点关注适应证、技术挑战和结果。
对29例行肝再次移植（re-LT）的患者进行回顾性研究，分析其生存结局和术后并发症。根据再次移植在初次移植后30天内还是超过30天进行，将患者分为早期和晚期再次移植组。
在总共3563例肝移植（28例活体供体和1例尸体供体肝移植）中，29例（0.81%）患者进行了肝再次移植。27例（93%）患者的初次移植为LDLT。再次移植在首次移植后的中位时间为26天进行。17例（59%）患者早期（30天内）进行了再次移植，12例（41%）患者晚期（超过30天）进行了再次移植。肝动脉血栓形成（53%）和早期移植物功能障碍（47%）是早期再次移植的适应证，而胆道并发症（50%）和慢性排斥反应（33%）是晚期再次移植的主要适应证。22例（75%）患者发生了再次移植后并发症，最常见的是革兰阴性菌败血症。再次移植后30天死亡率为27%（8/29）。死亡的主要原因是革兰阴性菌败血症。晚期再次移植组的死亡率（2例，16.6%）低于早期再次移植组（6例，35%）。
对于先前接受过LDLT的合适患者，使用活体供体进行再次移植是一种可行的选择。
