Ann Liver Transplant.  2021 May;1(1):48-57. 10.52604/alt.21.0010.

Living donor liver transplantation-associated retransplantation in adult patients

• Moon DB
• Hwang S
• Ahn CS
• Ha TY
• Song GW
• Jung DH
• Park GC

• KMID: 2560852
• DOI: http://doi.org/10.52604/alt.21.0010

Abstract

Adult-to-adult living donor liver transplantation (LDLT) has been established as a successful alternative to help solve the serious shortage problem of deceased donor (DD) grafts. LDLT-associated retransplantation has been much less frequently performed than DD liver transplantation-associated retransplantation due to lower incidence of primary nonfunction, advance in surgical technique for LDLT, and organ shortage for retransplantation. Common causes of retransplantation include immunologic rejection, primary nonfunction or severe dysfunction, biliary complications, recurrence of primary disease and vascular complications. LD-associated retransplantation can be classified into three types according to the sequences of the grafts used: LD-to-LD, LD-to-DD, and DD-to-LD because different surgical techniques should be considered according to the different sequences. They are also re-classified into two types according to the retransplantation timing: early and late. The most typical type of LDLT-associated retransplantation is early LD-to-DD retransplantation. Any cause of early graft failure can be indicated for this type of retransplantation if a DD organ is available. For early LD-to-LD retransplantation, the type of second liver graft and hepatic arterial inflow source should be considered prudently. Early DD-to-LD retransplantation has been usually applied to primary non-function of the first DD liver graft. Late LD-to-LD or DD-to-LD retransplantation is not recommended because of heavy adhesion and anatomical distortion. The outcome of LDLT-associated retransplantation appears to be inferior to that of DDto-DD retransplantation. There are several technical limitations. Procurement of a LD liver graft with long vascular stumps is not allowed. Thus, alternative methods of vascular reconstruction are often required, which have high technical difficulty. Furthermore, the timing of retransplantation is usually suboptimal, given the shortage of DD and LD grafts and the urgency involved with the failing first liver graft. Fundamental requirements for improving retransplantation results include expanding the donor pool and having a proper timing of retransplantation.

Keyword

Living donor; Deceased donor; Graft failure; Chronic rejection; Primary nonfunction