Liver retransplantation of more than two grafts for recurrent failure

Edip Akpinar, Gennaro Selvaggi, David Levi, Jang Moon, Seigo Nishida, Eddie Island, Werviston Defaria, Ernesto Pretto, Philip Ruiz, Andreas G. Tzakis

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Background. Transplantation of more than two livers for recurring graft failure has not been specifically addressed in the literature. Methods. A retrospective analysis was conducted from a total of 2527 overall liver transplants at our institution. Main indications for multiple retransplant included primary nonfunction, chronic rejection, hepatic artery thrombosis, and recurrent disease. Results. We identified 39 patients who received more than, two grafts (32 received 3 grafts, 5 received 4 grafts, and 2 received 5 grafts). All patients required interposition arterial grafts from the aorta and hepatojejunostomy for the biliary reconstruction. Seventeen patients are still alive at last follow-up. Perioperative mortality rates after 3rd, 4th, and 5th liver graft were 25%, 14%, and 50%, respectively. Patient and graft survival rates were 72% and 56% at 1 year, respectively. Median length of stay was 27 days and median graft survival, was 2.9 years. Conclusions. Selection of patients and a significant use of available resources are some of the important factors that clinicians need to take into account when dealing with multiple retransplantations. With such conditions, however, liver retransplantation of more than two grafts can be a life-saving procedure.

Original languageEnglish (US)
Pages (from-to)884-890
Number of pages7
Issue number7
StatePublished - Oct 15 2009


  • Hepatitis c
  • Liver retransplantation
  • Rejection

ASJC Scopus subject areas

  • Transplantation


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