Repeated transplantation (retransplantation) presents clinical, ethical and economical dilemmas for the medical community and the society. It is the only therapy for irreversible organ failure and represents from 10% to 22% of transplant activity worldwide. It is known that the patients’ survival rate after a second transplant is inferior to those after initial operation. A repeated transplantation is more surgically challenging procedure. Usually, it is more expensive primarily because of the longer ICU and hospital stay. The medical and financial problems related to retransplantation are compoundedby ethical issues. This procedure inevitably denies organs to first-time recipients. This topic is paramount for the society in the time of the critical organ shortage.
We would like to share our experience in approach to this difficult issues and hope that it will be helpful for the medical community as well as public in general.
Our medical center successfully performed combined liver-kidney transplant after two prior liver transplantations. We can realistically hope for a retransplantation survival rate to come close to the one of primary transplantation. We can achieve this result by careful selection of the suitable candidates, thorough planning of the procedure details and postoperative care.
We started with analysis of the available literature in the area of retransplantation looking for the major predictors of postoperative morbidity and mortality.We found out that the retransplantation is fully justifiable when performed electively and for the younger recipients.A very tight cooperation between the surgical, nursing teams, anesthesiologists and other technical personal in the operating room contributed to the success of this extremely challenging operation. Individualized postoperative care shortened patient’s ICU stay and allowed to discharge her home in two weeks.
Our unique experience with a repeat combined liver-kidney transplant opens a new prospective in the approach to the problem of the liver retransplantation.