• Med. J. Aust. · Nov 2020

    Outcomes for children after second liver transplantations are similar to those after first transplantations: a binational registry analysis.

    • Angus W Jeffrey, Gary P Jeffrey, Michael Stormon, Gordon Thomas, Edward O'Loughlin, Albert Shun, Winita Hardikar, Robert Jones, John McCall, Helen Evans, Graham Starkey, Peter Hodgkinson, Looi C Ee, David Moore, Catherine Mews, Geoff W McCaughan, Peter W Angus, Alan J Wigg, Michael Crawford, and Jonathan Fawcett.
    • Sir Charles Gairdner Hospital, Perth, WA.
    • Med. J. Aust. 2020 Nov 1; 213 (10): 464-470.

    ObjectiveTo assess long term graft and patient survival after donor liver retransplantation in children in Australia and New Zealand during 1986-2017; to determine the factors that influence survival.DesignRetrospective cohort analysis (registry data).Setting, ParticipantsAustralia and New Zealand Liver Transplant Registry data for all liver retransplantations in children (under 18 years of age), 1986-2017, in all four paediatric and six adult liver transplantation centres in the two countries.Main Outcome MeasuresGraft and patient survival at one, 5, 10 and 15 years.Results142 liver retransplantations were undertaken in children (59 during 1986-2000, 83 during 2001-2017). Kaplan-Meier survival analysis indicated that survival was significantly greater during 2001-2017 than 1986-2000 (P < 0.001). During 2001-2017, graft survival one year after retransplantation was 84%, at 5 years 75%, at 10 years 70%, and at 15 years 54%; patient survival was 89% at one year, 87% at 5 years, 87% at 10 years, and 71% at 15 years. Median time between transplantations was 0.2 years (IQR, 0.03-1.4 years) during 1986-2000, and 1.8 years (IQR, 0.1-6.8 years) during 2001-2017 (P = 0.002). The proportion of graft failures that involved split grafts was larger during 2001-2017 (35 of 83, 42%) than 1986-2000 (10 of 59, 17%). Graft type, cause of graft failure, and number of transplants did not influence survival following retransplantation.ConclusionSurvival for children following retransplantation is excellent. Graft survival is similar for split and whole grafts. Children on the liver waiting list requiring retransplantation should have the same access to donor grafts as children requiring a first transplant.© 2020 AMPCo Pty Ltd.

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