Incidence of Liver Retransplantation and Its Effect on Patient Survival H. Lang, G.C. Sotiropoulos, S. Beckebaum, I. Fouzas, E.P. Molmenti, O.S. Omar, G. Sgourakis, A. Radtke, S. Nadalin, F.H. Saner, M. Malagó, G. Gerken, A. Paul, and C.E. Broelsch ABSTRACT Purpose. The purpose of this study was to review our institutional experience with re–liver transplantation (OLT) after split and full-size OLT. Patients and methods. We evaluated data corresponding to retransplanted patients over an 8-year period who underwent deceased donor OLT at our institution. Variables analyzed included indications for primary OLT, and re-OLT, the type of graft used during the initial versus re-OLT, the time from initial to re-OLT, and patient survival after re-OLT. Results. Sixty-four of 697 first OLT (9.2%) required re-OLT. Forty-nine cases were among 637 (7.6%) full-size OLT, while 15 were among 60 (25%) split OLT (P  .001). Median time to re-OLT was 8 days (range = 1–1885 days). Main indications for re-OLT were primary nonfunction/initial poor function (44%), hepatic artery thrombosis (26%), biliary complications (11%), and hepatitis C recurrence (6%). Forty-eight percent of the re-OLTs were performed within the first posttransplant week. The overall survival for these 64 patients was 55% and 48% at 1 and 3 years after the primary OLT, and 44% at both 1 and 3 years after the re-OLT, respectively. Conclusions. The overall incidence of re-OLT remains 9%. Approximately half of all re-OLT occured within the first posttransplant week. Early retransplantation was associ- ated with the best patient survival. Overall survival after re-OLT was about 10% to 20% lower than that after primary OLT. L IVER TRANSPLANTATION (OLT) is the only effec- tive treatment for patients with end-stage liver dis- ease. Mortality has decreased dramatically over time as a result of refinements in surgical techniques, new immuno- suppressive regimens, and improvements in perioperative clinical management. However, re-OLT is still necessary in cases of primary graft nonfunction, technical difficulties, biliary or immunologic complications, and recurrence of the primary disease. 1,2 The purpose of this study was to evalu- ate our institutional experience with re-OLT after deceased donor OLT. PATIENTS AND METHODS We reviewed prospectively collected data corresponding to patients who underwent re-OLT after deceased donor split or full-size OLT at our institution during an 8-year period (April 1998 –August 2006). Variables included the indications for re-OLT (primary nonfunction/initial poor function, technical complications, biliary complications, immunologic complications, and recurrence of the primary disease), the type of graft transplanted (split versus full-size) as well as median time between initial OLT and re-OLT, type of graft used for the re-OLT, and patient survival. Survival analysis used the Kaplan-Meier method. A log-rank test was employed to compare survivals. Univariate and multivariate anal- yses were performed using proportional hazard (Cox) regression. From the Department of General and Abdominal Surgery (H.L., G.C.S., G.S., A.R.), Johannes Gutenberg University Hospital, Mainz, Germany; the Departments of General, Visceral, and Transplantation Surgery (H.L., G.C.S., S.B., I.F., E.P.M., O.S.O., G.S., A.R., S.N., F.H.S., M.M., A.P., C.E.B.) and Gastroenterol- ogy and Hepatology (G.G.), University Hospital Essen, Essen, Germany; and the Organ Transplant Unit Hippocration University Hospital (I.F.), Salonica, Greece. Address reprint requests to Prof Hauke Lang, MA, MD, FACS, Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Langenbeckstraße 1, 55131 Mainz, Germany. E-mail: lang@ach.klinik.uni-mainz.de Crown Copyright © 2008 Published by Elseiver Inc. All rights reserved. 0041-1345/08/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2008.09.039 Transplantation Proceedings, 40, 3201–3203 (2008) 3201