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Intercurrent infection predicts mortality in patients with late hepatic artery thrombosis listed for liver retransplantation†
Article first published online: 26 SEP 2012
Copyright © 2012 American Association for the Study of Liver Diseases
Volume 18, Issue 11, pages 1353–1360, November 2012
How to Cite
Leithead, J. A., Smith, M. R., Materacki, L. B., Sagar, V. M., Gunson, B. K., Bramhall, S. R., Mutimer, D. J. and Shah, T. (2012), Intercurrent infection predicts mortality in patients with late hepatic artery thrombosis listed for liver retransplantation. Liver Transpl, 18: 1353–1360. doi: 10.1002/lt.23518
Abbreviations: CI, confidence interval; eGFR, estimated glomerular filtration rate; HAT, hepatic artery thrombosis; HR, hazard ratio; INR, international normalized ratio; IQR, interquartile range; MDR, multidrug-resistant; MELD, Model for End-Stage Liver Disease.
- Issue published online: 26 OCT 2012
- Article first published online: 26 SEP 2012
- Accepted manuscript online: 28 JUL 2012 07:21AM EST
- Manuscript Accepted: 1 JUL 2012
- Manuscript Received: 2 APR 2012
Liver retransplantation for late hepatic artery thrombosis (HAT) is considered the treatment of choice for select patients. Nevertheless, there is a paucity of data to aid decision making in this setting. The aims of this single-center study of patients listed for late HAT were (1) to determine variables associated with wait-list mortality, (2) to describe survival after retransplantation, and (3) to determine variables associated with mortality after retransplantation. Seventy-eight patients were diagnosed with late HAT (incidence = 3.9%). Of the 49 patients listed for retransplantation, 9 died on the waiting list and 36 were retransplanted. The estimated 1-year survival after listing for retransplantation was 53.7%. Only multidrug-resistant (MDR) bacteria–positive cultures were predictive of wait-list mortality (P = 0.01). After retransplantation, the estimated 1- and 5-year patient survival was 71.9% and 62.5%, respectively. Increasing Model for End-Stage Liver Disease score (overall P = 0.007), MDR bacteria–positive cultures (P = 0.047), and continued antibiotic therapy (P = 0.001) at the time of retransplantation were risk factors for post retransplant death. In conclusion, patients who undergo liver retransplantation for late HAT have satisfactory outcomes. However, the presence of active infection and MDR bacteria–positive cultures should be taken into account when risk stratifying such patients. Liver Transpl, 2012. © 2012 AASLD.