Intercurrent infection predicts mortality in patients with late hepatic artery thrombosis listed for liver retransplantation

Authors

  • Joanna Agnes Leithead,

    Corresponding author
    1. Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
    2. National Institute for Health Research Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, United Kingdom
    • Clinical Lecturer in Hepatology, Centre for Liver Research, NIHR Biomedical Research Unit, Institute of Biomedical Research (5th floor) University of Birmingham, Edgbaston, Birmingham, United Kingdom B15 2TT
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    • Telephone: 0121 415 8700; FAX: 0121 415 8701

  • Matthew R. Smith,

    1. Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
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  • Luke B. Materacki,

    1. Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
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  • Vandana M. Sagar,

    1. Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
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  • Bridget K. Gunson,

    1. National Institute for Health Research Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, United Kingdom
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  • Simon R. Bramhall,

    1. Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
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  • David J. Mutimer,

    1. Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
    2. National Institute for Health Research Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, United Kingdom
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  • Tahir Shah

    1. Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
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  • 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.

Abstract

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.

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