When shouldn't we retransplant?

Abstract

Key Points 1 In the setting of early graft failure after primary transplantation, orthotopic liver retransplantation (re‐OLT) should be undertaken within the first 7 days, but it should be discouraged within 8‐30 days, since re‐OLT within this intermediate frame is associated with the worst results. 2 Late retransplantation should be cautioned in severely ill patients who exhibit Model for End‐Stage Liver Disease (MELD) scores >25, require mechanical ventilation, have advanced renal insufficiency, and in advanced‐age recipients. 3 Re‐OLT should not be undertaken with extended and older donors particularly when retransplantation for recurrent disease is considered. 4 Prognostic models that take into account the severity of disease and the effect of the organ to be transplanted should be developed to better predict outcomes after re‐OLT. 5 Accurate definitions of acceptable outcomes after retransplantation and “futile re‐OLT” are desperately needed. (Liver Transpl 2005;11:S14–S20.)