Hepatocyte transplantation program: Lessons learned and future strategies.

This review aims to share the lessons we learned over time during the setting of the hepatocyte transplantation (HT) program at the Hepatic Cell Therapy Unit at Hospital La Fe in Valencia. New sources of liver tissue for hepatocyte isolation have been explored. The hepatocyte isolation and cryopreservation procedures have been optimized and quality criteria for assessment of functionality of hepatocyte preparations and suitability for HT have been established. The results indicate that: (1) Only highly viable and functional hepatocytes allow to recover those functions lacking in the native liver; (2) Organs with steatosis (≥ 40%) and from elderly donors are declined since low hepatocyte yields, viability and cell survival after cryopreservation, are obtained; (3) Neonatal hepatocytes are cryopreserved without significant loss of viability or function representing high-quality cells to improve human HT; (4) Cryopreservation has the advantage of providing hepatocytes constantly available and of allowing the quality evaluation and suitability for transplantation; and (5) Our results from 5 adults with acute liver failure and 4 from children with inborn metabolic diseases, indicate that HT could be a very useful and safe cell therapy, as long as viable and metabolically functional human hepatocytes are used.

A score model for the continuous grading of early allograft dysfunction severity.

Early allograft dysfunction (EAD) dramatically influences graft and patient outcomes. A lack of consensus on an EAD definition hinders comparisons of liver transplant outcomes and management of recipients among and within centers. We sought to develop a model for the quantitative assessment of early allograft function [Model for Early Allograft Function Scoring (MEAF)] after transplantation. A retrospective study including 1026 consecutive liver transplants was performed for MEAF score development. Multivariate data analysis was used to select a small number of postoperative variables that adequately describe EAD. Then, the distribution of these variables was mathematically modeled to assign a score for each actual variable value. A model, based on easily obtainable clinical parameters (ie, alanine aminotransferase, international normalized ratio, and bilirubin) and scoring liver function from 0 to 10, was built. The MEAF score showed a significant association with patient and graft survival at 3-, 6- and 12-month follow-ups. Hepatic steatosis and age for donors; cold/warm ischemia times and postreperfusion syndrome for surgery; and intensive care unit and hospital stays, Model for End-Stage Liver Disease and Child-Pugh scores, body mass index, and fresh frozen plasma transfusions for recipients were factors associated significantly with EAD. The model was satisfactorily validated by its application to an independent set of 200 patients who underwent liver transplantation at a different center. In conclusion, a model for the quantitative assessment of EAD severity has been developed and validated for the first time. The MEAF provides a more accurate graft function assessment than current categorical classifications and may help clinicians to make early enough decisions on retransplantation benefits. Furthermore, the MEAF score is a predictor of recipient and graft survival. The standardization of the criteria used to define EAD may allow reliable comparisons of recipients' treatments and transplant outcomes among and within centers.

Metabolomics discloses donor liver biomarkers associated with early allograft dysfunction.

BACKGROUND & AIMS: Early allograft dysfunction (EAD) dramatically influences graft and patient outcome after orthotopic liver transplantation and its incidence is strongly determined by donor liver quality. Nevertheless, objective biomarkers, which can assess graft quality and anticipate organ function, are still lacking. This study aims to investigate whether there is a preoperative donor liver metabolomic biosignature associated with EAD. METHODS: A comprehensive metabolomic profiling of 124 donor liver biopsies collected before transplantation was performed by mass spectrometry coupled to liquid chromatography. Donor liver grafts were classified into two groups: showing EAD and immediate graft function (IGF). Multivariate data analysis was used to search for the relationship between the metabolomic profiles present in donor livers before transplantation and their function in recipients. RESULTS: A set of liver graft dysfunction-associated biomarkers was identified. Key changes include significantly increased levels of bile acids, lysophospholipids, phospholipids, sphingomyelins and histidine metabolism products, all suggestive of disrupted lipid homeostasis and altered histidine pathway. Based on these biomarkers, a predictive EAD model was built and further evaluated by assessing 24 independent donor livers, yielding 91% sensitivity and 82% specificity. The model was also successfully challenged by evaluating donor livers showing primary non-function (n=4). CONCLUSIONS: A metabolomic biosignature that accurately differentiates donor livers, which later showed EAD or IGF, has been deciphered. The remarkable metabolomic differences between donor livers before transplant can relate to their different quality. The proposed metabolomic approach may become a clinical tool for donor liver quality assessment and for anticipating graft function before transplant.

Fístulas arteriovenosas uterinas tras legrado. Manejo histeroscópico / Uterine arteriovenous malformations after curettage. Hysteroscopic management

Las fístulas arteriovenosas uterinas o malformaciones arteriovenosas uterinas constituyen una de esas afecciones extrañas y poco conocidas que dan lugar a cuadros de metrorragia que pueden llegar a comprometer la vida de la paciente. Estas pueden ser congénitas o adquiridas. Queremos revisar en este artículo las fístulas arteriovenosas adquiridas que acontecen tras la realización de un legrado uterino, su incidencia y el manejo histeroscópico, hasta donde nosotros conocemos, los distintos tratamientos se han limitado a manejo expectante o con ergotínicos, embolización o histerectomía, sin valorar la opción histeroscópica. Pensamos que la resolución de esta afección por vía histeroscópica puede abrir una nueva vía de terapia para las fístulas arteriovenosas uterinas adquiridas producidas tras la realización de un legrado uterino (AU)

Uterine arteriovenous malformations are uncommon entities that may lead to life-threatening genital bleeding. These malformations can be congenital or acquired. In this article, we review uterine arteriovenous malformations occurring after curettage, their incidence, and their hysteroscopic management. To our knowledge, the distinct therapeutic options are limited to expectant management with or without methylergometrine maleate, embolization and hysterectomy, without considering hysteroscopy. We believe that hysteroscopic management could be a new treatment option for uterine arteriovenous malformation occurring after curettage (AU)

Estado actual y perspectivas futuras del trasplante de hepatocitos / Current status and future perspectives of hepatocyte transplantation

Existe un gran número de enfermedades hepáticas para las cuales el único tratamiento efectivo es el trasplante hepático. La disparidad entre el número de potenciales beneficiarios y de órganos disponibles motiva la búsqueda de nuevas alternativas de tratamiento, entre las que se encuentra el trasplante celular hepático (TCH). Esta terapia representa una alternativa de tratamiento en estos pacientes, sin embargo, la falta de unanimidad de criterios respecto a las indicaciones y técnica, los diferentes protocolos de criopreservación así como la distinta metodología para valorar la respuesta a esta terapia pone de manifiesto la necesidad de una conferencia de consenso que unifique criterios, planteando posibles estrategias futuras que mejoren la técnica y optimicen los resultados. Nuestro objetivo es realizar una revisión y puesta al día del estado actual del TCH, enfatizando las futuras líneas de investigación que tratan de solucionar los problemas y mejorar los resultados de esta terapia

The imbalance between the number of potential beneficiaries and available organs, originates the search for new therapeutic alternatives, such as Hepatocyte transplantation (HT).Even though this is a treatment option for these patients, the lack of unanimity of criteria regarding indications and technique, different cryopreservation protocols, as well as the different methodology to assess the response to this therapy, highlights the need of a Consensus Conference to standardize criteria and consider future strategies to improve the technique and optimize the results. Our aim is to review and update the current state of hepatocyte transplantation, emphasizing the future research attempting to solve the problems and improve the results of this treatment

Neonatal livers: a source for the isolation of good-performing hepatocytes for cell transplantation.

Hepatocyte transplantation is an alternative therapy to orthotopic liver transplantation for the treatment of liver diseases. However, the supply of hepatocytes is limited given the shortage of organs available to isolate good-functioning quality cells. Neonatal livers may be a potential source alternative to adult livers to obtain good-performing hepatic cells for hepatocyte transplantation, which has not yet been explored profoundly. High-yield preparations of viable hepatocytes were isolated from 1- to 23-day-old liver donors, cryopreserved, and banked. Cell integrity and functional quality assessment were performed after thawing. Neonatal hepatocytes showed better postthawing recovery compared with adult hepatocytes, as shown by the viability values that did not differ significantly from freshly isolated cells, a higher expression of adhesion molecules (ß1-integrin, ß-catenin, and E-cadherin), better attachment efficiency, cell survival, and a lower number of apoptotic cells. The metabolic performance of thawed hepatocytes has been assessed by ureogenesis and drug-metabolizing capability (cytochrome P450 and UDP-glucuronosyltransferase enzymes). CYP2A6, CYP2C9, CYP2E1, and CYP3A4 activities were found in all cell preparations, while CYP1A2, CYP2B6, CYP2C19, and CYP2D6 activities were detected only in hepatocytes from a few neonatal donors. The expression of UGT1A1 and UGT1A9 (transcripts and protein) was detected in all hepatocyte preparations, while activity was measured only in some preparations, probably due to lack of maturity of the enzymes. However, isoforms UGT1A6 and UGT2B7 showed considerable activity in all preparations. Compared to adult liver, the hepatocyte isolation procedure in neonatal livers also provides thawed cell suspensions with a higher proportion of hepatic progenitor cells (EpCAM(+) staining), which could also participate in regeneration of liver parenchyma after transplantation. These results could imply important advantages of neonatal hepatocytes as a source of high-quality cells to improve human hepatocyte transplantation applicability.

[Current status and future perspectives of hepatocyte transplantation]. / Estado actual y perspectivas futuras del trasplante de hepatocitos.

The imbalance between the number of potential beneficiaries and available organs, originates the search for new therapeutic alternatives, such as Hepatocyte transplantation (HT).Even though this is a treatment option for these patients, the lack of unanimity of criteria regarding indications and technique, different cryopreservation protocols, as well as the different methodology to assess the response to this therapy, highlights the need of a Consensus Conference to standardize criteria and consider future strategies to improve the technique and optimize the results.Our aim is to review and update the current state of hepatocyte transplantation, emphasizing the future research attempting to solve the problems and improve the results of this treatment.

Comparison of results of combined liver-kidney transplantation vs. isolated liver transplantation.

INTRODUCTION: Combined liver-kidney transplantation (LKT) is the best therapeutic option for patients with end-stage liver and kidney disease. OBJECTIVES: To analyze baseline characteristics and clinical outcome of LKT compared to isolated liver transplantation (LT). MATERIAL AND METHODS: The study included 16 LKT performed between 1998 and 2006 and 32 LT matched by age, sex, date and indication for transplantation. Demographic, pretransplant, post-transplant and survival variables were analyzed. RESULTS: As planned by the study design, mean age, distribution by sex and indication for LT were similar between groups. The most common indication for LT was HCV- and/or alcohol-induced cirrhosis. The most common indication for KT was renal failure, in most cases secondary to glomerulonephritis. Twelve patients (69%) were on dialysis before LKT. Hepatocellular carcinoma and diabetes mellitus pre-transplantation were similar between groups. However pretransplant arterial hypertension (AHT) was higher in LKT than LT (50% vs. 19%; p = 0.02). In the post-transplant: reoperation due to bleeding, bacterial infections, liver rejection, AHT and median creatinine levels at 1st and 3rd years were similar in LKT and LT. In contrast, early post-transplant dialysis was higher in LKT than LT (31% vs. 3%; p = 0.01). Survival rates at 1st, 3rd, 5th and 7th years were similar in both groups (87.5%, 74%, 74% and 66% vs. 81%, 75%, 75% and 75% in LT and LKT, respectively). CONCLUSIONS: LKT is an effective therapeutic option in patients with end-stage liver and kidney disease. Most early and late complications and long-term survival are similar to those observed with LT.

Use of aortic extension cuffs for preserving hypogastric blood flow in endovascular aneurysm repair with aneurysmal involvement of common iliac arteries.

BACKGROUND: Intentional hypogastric artery covering during endovascular repair of abdominal aortic aneurysms (EVAR) can carry a non-negligible rate of complications; to preserve pelvic blood flow, several approaches are in use, such as sandwich techniques, branched iliac devices, or the use of aortic extender cuffs in a bell-bottom configuration. We assess the performance of the latter for treatment of common iliac artery aneurysms during EVAR. METHODS: Prospective gathering of data in 21 dilated common iliac arteries (18-25 mm) with coexisting abdominal aorta aneurysm, which were treated from 2005 to 2010 and received a GORE(®) Excluder endograft and one (n = 14) or several aortic extenders in a bell-bottom configuration. Control group consisted of 136 EVARs performed with the same device in the same time frame. Median follow-up was of 47 months, with contrast-enhanced computed tomography assessment 1 month after the procedure and yearly thereafter. RESULTS: Age and comorbidities were homogeneously distributed among groups, although the aortic aneurysm diameter was lower in the bell-bottom group (50 mm vs. 58.2 mm, P < 0.001). There was no 30-day mortality registered in this group, and only one patient died during follow-up (5.3%), without relation with the aneurysmal disease. No significant differences were found in reintervention (15.8% vs. 14.7%, P = 0.707) or endoleak rates (36.8% vs. 38.9%, Fisher P = 1). There were no type I and four type II endoleaks, two of which precised treatment for sac growth. Endoleak-free survival (P = 0.994) and reintervention-free survival (P = 0.563) did not show differences either. CONCLUSION: Bell-bottom technique is a feasible and safe alternative for preserving hypogastric blood flow, and does not imply a higher risk of reintervention or endoleak at 3-year follow-up.

Nuevas alternativas al trasplante hepático: trasplante de hepatocitos / New alternatives to liver transplantation: Transplantation of hepatocytes

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Diagnóstico y tratamiento de las complicaciones de la arteria hepática / No disponible

No disponible

Effect of calcineurin inhibitors in the outcome of liver transplantation in hepatitis C virus-positive recipients.

BACKGROUND: There is a paucity of good studies evaluating the impact of calcineurin inhibitors on posttransplantation outcome in hepatitis C virus (HCV)-infected liver transplant (LT) recipients. METHODS: We sought to determine whether there are differences on posttransplantation survival and histologic recurrence in HCV-LT recipients based on initial immunosuppression (IS) by conducting a prospective study comparing tacrolimus (Tac) versus cyclosporine-based IS in patients undergoing LT between 2001 and 2007. Protocol liver biopsies were performed. RESULTS: Baseline characteristics (demographics, liver function at LT, genotype distribution, donor, surgery, and IS except for the type of calcineurin inhibitor) did not differ between groups. Severe disease (defined as bridging fibrosis, cirrhosis, cholestatic hepatitis, or allograft loss or death because of recurrent disease in the first year) was present in 67 of 253 (26.5%) and was equally distributed in the CsA and Tac groups (27% vs. 26%; P=0.68). Two thirds of protocol biopsies performed at 1 year showed some fibrosis without differences between CsA and Tac groups (75% vs. 70%). Advanced fibrosis (bridging fibrosis and cirrhosis) was diagnosed in 30% CsA and 24.5% Tac patients (P=NS). No differences in survival at 1 and 7 years were observed (83% and 67% vs. 78% and 64%, respectively, P=0.4). In summary, in patients undergoing LT for HCV-related liver disease, posttransplantation outcome is not related to the calcineurin inhibitor used.

Papel de la resección quirúrgica en las metástasis hepáticas de carcinoma de mama: experiencia en los últimos 10 años en un hospital de referencia / Role of resection surgery in breast cancer liver metastases. Experience over the last 10 years in a reference hospital

Introducción: Las metástasis hepáticas de carcinoma de mama (MHCM) se consideran una enfermedad sistémica cuyo tratamiento principal está basado en la quimioterapia, mientras que el papel de la resección quirúrgica sigue sin estar bien definido. El objetivo de este estudio fue analizar la supervivencia y los factores pronósticos predictivos de mortalidad en las pacientes con MHCM tratadas con resección hepática. Material y métodos: Entre 1998–2008 intervinimos a 21 pacientes, realizando resección hepática en 12. Recogimos distintas variables retrospectivamente. Resultados: La edad media fue de 48 años. El estadio más frecuente del tumor primario fue el i , con cirugía curativa en todos los casos, y recibió tratamiento adyuvante la mayoría (66,7%). Las MHCM fueron fundamentalmente metacrónicas (83,3%). Recibió tratamiento neoadyuvante el 66,7%. La resección hepática fue R0 en todos los casos con una morbilidad nula y una mortalidad a largo plazo del 8,3%. Recibió quimioterapia adyuvante el 66,7%. La supervivencia estimada fue del 67% al año y del 23% a los 5 años. Un periodo libre de enfermedad entre el tumor primario y la aparición de metástasis menor de 24 meses se asoció a peor supervivencia. Conclusiones: La resección de las MHCM dentro del manejo multimodal es un tratamiento seguro en pacientes seleccionadas (AU)

Introduction: Breast cancer liver metastases (BCLM) are considered as a systemic disease which is mainly treated with chemotherapy, while the role of surgical resection still remains to be well defined. The aim of the study is to analyse the survival and prognostic factors predictive of mortality in patients with BCLM treated by liver resection. Material and methods: A total of 21 patients were operated on between 1998–2008, with liver resection being performed on 12. We retrospectively collected several variables. Results: The mean age was 48 years. The most frequent stage was I, with curative surgery in all cases, and the majority (66.7%) received adjuvant treatment. The BCLM were mainly meta metachronic (83.3%). The majority (66.7%) received neoadjuvant treatment. The liver resection was R0 in all cases with no morbidity and a mortality in the long term of 8.3%. Two-thirds received chemotherapy. The estimated survival at one year was 67% and 23% at 5 years. A disease free period of less than 24 months between the primary tumour and the appearance of metastasis was associated with a worse survival. Conclusions: Resection of BCLM within a multimodal treatment is safe in selected patients (AU)

[Role of resection surgery in breast cancer liver metastases. Experience over the last 10 years in a reference hospital]. / Papel de la resección quirúrgica en las metástasis hepáticas de carcinoma de mama: experiencia en los últimos 10 años en un hospital de referencia.

INTRODUCTION: Breast cancer liver metastases (BCLM) are considered as a systemic disease which is mainly treated with chemotherapy, while the role of surgical resection still remains to be well defined. The aim of the study is to analyse the survival and prognostic factors predictive of mortality in patients with BCLM treated by liver resection. MATERIAL AND METHODS: A total of 21 patients were operated on between 1998-2008, with liver resection being performed on 12. We retrospectively collected several variables. RESULTS: The mean age was 48 years. The most frequent stage was I, with curative surgery in all cases, and the majority (66.7%) received adjuvant treatment. The BCLM were mainly meta metachronic (83.3%). The majority (66.7%) received neoadjuvant treatment. The liver resection was R0 in all cases with no morbidity and a mortality in the long term of 8.3%. Two-thirds received chemotherapy. The estimated survival at one year was 67% and 23% at 5 years. A disease free period of less than 24 months between the primary tumour and the appearance of metastasis was associated with a worse survival. CONCLUSIONS: Resection of BCLM within a multimodal treatment is safe in selected patients.

Trasplante celular hepático: un nuevo tratamiento en las enfermedades hepáticas / Hepatic cell transplantation: A new therapy in liver diseases

El transplante hepático es el único tratamiento efectivo existente para las enfermedades hepáticas en fase terminal. La desproporción entre la demanda y la oferta de órganos constituye su principal limitación y plantea la necesidad de buscar alternativas al trasplante hepático. El trasplante celular hepático o trasplante de hepatocitos humanos constituye, en el momento actual, la mejor opción terapéutica sustitutiva. Consiste en trasplantar hepatocitos humanos totalmente diferenciados a un órgano receptor, en cantidad suficiente para que estos sobrevivan y restauren la función hepática normal, basándose en la capacidad de regeneración hepática. Este tratamiento está en fase clinicoexperimental, y se ha realizado en pacientes con errores congénitos del metabolismo, fallo hepático fulminante y fallo hepático agudo o crónico como puente al trasplante convencional. En el Hospital La Fe de Valencia hemos puesto en marcha y llevado a cabo el primer trasplante celular hepático en España, por tanto, esto abre una nueva línea de trabajo dentro del Programa de Trasplante Hepático (AU)

Liver transplantation has been remarkably effective in the treatment in patients with end-stage liver disease. However, disparity between solid-organ supply and increased demand is the greatest limitation, resulting in longer waiting times and increase in mortality of transplant recipients. This situation creates the need to seek alternatives to orthotopic liver transplantation.Hepatocyte transplantation or liver cell transplantation has been proposed as the best method to support patients. The procedure consists of transplanting individual cells to a recipient organ in sufficient quantity to survive and restore the function. The capacity of hepatic regeneration is the biological basis of hepatocyte transplantation. This therapeutic option is an experimental procedure in some patients with inborn errors of metabolism, fulminant hepatic failure and acute and chronic liver failure, as a bridge to orthotopic liver transplantation. In the Hospital La Fe of Valencia, we performed the first hepatocyte trasplantation in Spain creating a new research work on transplant program (AU)

Hemangioendotelioma epitelioide: un tumor hepatico infrecuente / Epithelioid hemangioendothelioma: an uncommon liver tumor

Resumen Presentamos un caso de una paciente, remitida a nuestra unidad por presentar una lesión hepática sólida, sugestiva de metástasis, que tras biopsia, fue diagnosticada de hemangioendotelioma epitelioide hepático.ResumenSe trata de una entidad infrecuente, de curso clínico y pronóstico impredecibles, con un potencial letal difícil de prever. Destacamos su importancia por ser una entidad poco frecuente, en la que hay que pensar cuando detectamos una lesión hepática única, debiendo ser incluida en el diagnóstico diferencial con las metástasis hepáticas. Subrayamos la rareza del tumor, su presentación como lesión hepática única y la indicación de tratamiento quirúrgico.ResumenDescribimos las características clínico-patológicas de esta lesión, aportando un nuevo caso de hemangioendotelioma epitelioide hepático y analizando las distintas opciones terapéuticas(AU)

Abstract We report the case of a female patient who was referred to our unit because of a solid liver tumor, suggestive of metastasis. After biopsy, the patient was diagnosed with epithelioid hemangioendothelioma of the liver.AbstractEpithelioid hemangioendothelioma is a rare entity with an unpredictable, potentially fatal, clinical course and outcome. Due to its rarity, this entity should be considered when a solitary hepatic lesion is detected and should be included in the differential diagnosis with liver metastases. We highlight the infrequency of this tumor, its presentation as a solitary hepatic lesion and the indication of surgical treatment.AbstractWe describe the clinical and pathological characteristics of epithelioid hemangioendothelioma of the liver and report a new case of this entity. The distinct therapeutic options are discussed(AU)

[Hepatic cell transplantation: a new therapy in liver diseases]. / Trasplante celular hepático: un nuevo tratamiento en las enfermedades hepáticas.

Liver transplantation has been remarkably effective in the treatment in patients with end-stage liver disease. However, disparity between solid-organ supply and increased demand is the greatest limitation, resulting in longer waiting times and increase in mortality of transplant recipients. This situation creates the need to seek alternatives to orthotopic liver transplantation.Hepatocyte transplantation or liver cell transplantation has been proposed as the best method to support patients. The procedure consists of transplanting individual cells to a recipient organ in sufficient quantity to survive and restore the function. The capacity of hepatic regeneration is the biological basis of hepatocyte transplantation. This therapeutic option is an experimental procedure in some patients with inborn errors of metabolism, fulminant hepatic failure and acute and chronic liver failure, as a bridge to orthotopic liver transplantation. In the Hospital La Fe of Valencia, we performed the first hepatocyte transplantation in Spain creating a new research work on transplant program.

[Epithelioid hemangioendothelioma: an uncommon liver tumor]. / Hemangioendotelioma epitelioide: un tumor hepatico infrecuente.

We report the case of a female patient who was referred to our unit because of a solid liver tumor, suggestive of metastasis. After biopsy, the patient was diagnosed with epithelioid hemangioendothelioma of the liver. Epithelioid hemangioendothelioma is a rare entity with an unpredictable, potentially fatal, clinical course and outcome. Due to its rarity, this entity should be considered when a solitary hepatic lesion is detected and should be included in the differential diagnosis with liver metastases. We highlight the infrequency of this tumor, its presentation as a solitary hepatic lesion and the indication of surgical treatment. We describe the clinical and pathological characteristics of epithelioid hemangioendothelioma of the liver and report a new case of this entity. The distinct therapeutic options are discussed.

Indicaciones y resultados de retrasplante hepático: experiencia del hospital universitario La Fe (1.181 pacientes) / Indications and results of liver retransplantation: experience with 1181 patients in the hospital universitario La Fe

Resumen El retrasplante hepático (ReTH) constituye la única opción terapéutica para el fracaso irreversible de un injerto hepático y corresponde a un 2,9–24,0% de todos los trasplantes hepáticos (TH). Técnicamente es difícil y conlleva un elevado índice de morbilidad inmediata y una menor supervivencia que el TH primario. Nuestro objetivo fue determinar la tasa de ReTH y las indicaciones, morbilidad, mortalidad postoperatoria y supervivencia actuarial del paciente retrasplantado. Pacientes y método Estudio de cohorte histórica de 1.181 pacientes trasplantados entre los años 1991 y 2006.ResultadosDe los 1.260 TH realizados, 79 fueron ReTH. Al momento del primer TH, no hubo diferencias con aquellos pacientes que no necesitaron ReTH. La tasa de ReTH fue del 6,3% y las causas más frecuentes fueron: trombosis de la arteria hepática (31,6%), recidiva de la cirrosis por VHC (30,4%) y fallo primario del injerto (21,5%). Los tiempos de isquemia, síndrome de reperfusión y congestión hepática no difieren entre el TH primario y el ReTH. Por el contrario, la transfusión de hematíes fue mayor en el ReTH (6,3±4,9 vs 3,5±3,0 unidades, p<0,001). La morbilidad y mortalidad postoperatoria (hasta los 30 días posterior al TH) fue mayor en los pacientes retrasplantados (68,4 vs 57,0%, p=0,04 y 25,3 vs 10,9%, p<0,001; respectivamente). La supervivencia actuarial a 1 y 5 años fue 83% y 69% en aquellos sin ReTH, 71% y 61% en ReTH precoz y 64% y 34% en ReTH tardío (p<0,001).Conclusiones Pese a una elevada morbilidad y mortalidad del ReTH, parece que esta alternativa terapéutica continúa siendo válida en aquellos pacientes con una pérdida precoz del injerto hepático. Por el contrario, cuando la pérdida del injerto es tardía, se hace necesario definir, cuales serían los resultados mínimos aceptables para indicar el ReTH y qué pacientes se pueden beneficiar con este tratamiento (AU)

Abstract Liver retransplantation (LrT) is the only therapeutic option for irreversible failure of a hepatic graft and accounts for 2.9&%#x02013;24.0% of all liver transplantations (LT). It is technically difficult and has a high level of immediate morbidity and a lower survival than primary LT. Our aim was to determine the rate of LrT and its indications, morbidity, post-operative mortality and actuarial survival in the retransplanted patient.Patients and method A historical cohort study of 1181 patients transplanted between 1991 and 2006.ResultsOf the 1260 LT performed, 79 were LrT. At the time of the first LT there were no differences between those patients and those that did not require an LrT. The LrT rate was 6.3% and the most frequent causes were: hepatic artery thrombosis (31.6%), recurrence of cirrhosis due the HVC (30.4%) and primary graft (21.5%). The ischemia times, perfusion syndrome and hepatic congestion were no different between the primary LT and the LrT. On the other hand, red cell transfusions were higher in LrT (6.3±4.9 vs. 3.5±3.0 units, P<0.001). The post-operative morbidity and morbidity (up to 30 days after the LT) was higher in retransplanted patients (68.4% vs. 57.0%, P=0.04 and 25.3% vs. 10.9%, P<0.001; respectively). The actuarial survival at 1 and 5 years was 83% and 69% in those without LrT, 71% and 61% in early LrT and 64% and 34% in delayed LrT (P<0.001).Conclusions Despite the increased morbidity and mortality of LrT, it appears that this treatment alternative is still valid in those patients with an early loss of the liver graft. On the other hand, when the graft loss is delayed, it needs to be defined, what would be the minimum acceptable results to indicate LrT and which patients could benefit from this treatment (AU)