Retransplantation for hepatic allograft failure: Prognostic modeling and ethical considerations

Authors

  • Scott W. Biggins,

    1. Department of Medicine, Portland Veterans Affairs Medical Center and Oregon Health Sciences University, Portland, OR
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  • Athena Beldecos,

    1. Department of Medicine, Portland Veterans Affairs Medical Center and Oregon Health Sciences University, Portland, OR
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  • John M. Rabkin,

    1. Department of Surgery, Portland Veterans Affairs Medical Center and Oregon Health Sciences University, Portland, OR
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  • Hugo R. Rosen MD

    Corresponding author
    1. Department of Medicine, Portland Veterans Affairs Medical Center and Oregon Health Sciences University, Portland, OR
    • Division of Gastroenterology/Hepatology, Portland VA Medical Center/OHSU, PO Box 1034, P3-GI, 3710 SW US Veterans Hospital Rd, Portland, OR 97207. Telephone: 503-273-5318; FAX: 503-273-5348
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Abstract

Retransplantation already accounts for 10% of all liver transplants performed, and this percentage is likely to increase as patients live long enough to develop graft failure from recurrent disease. Overall, retransplantation is associated with significantly diminished survival and increased costs. This review summarizes the current causes of graft failure after primary liver transplant, prognostic models that can identify the subset of patients for retransplantation with outcomes comparable to primary transplantation, and ethical considerations in this setting, i.e., outcomes-based versus urgency-based approaches.

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