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Liver transplant is a life-saving therapy for patients with end stage liver disease and liver cancer. Liver re-transplantation cases are usually more challenging and riskier than primary surgery, they require careful consideration and larger recourse utilization. Decision making on who receives transplantation surgery includes individual patient risks and benefits, physician judgment, specific transplant center policies, surgical experience, geographic organ availability, and ethical considerations. Several mathematical models have been developed to predict survival after re-transplantation. All models show that survival is better in younger patients with greater than two months between transplants, and surgery done before severe decompensation of the patient. The most common cause of early postoperative complications and death after these surgeries was infection leading to sepsis, and very often to septic shock. Early recognition and treatment of sepsis will benefit patient survival after re-transplantation, and lessen the economical burden related to prolonged hospital stay. A controversial topic in the treatment of septic shock remains the role and utility of extracorporeal membrane oxygenation (ECMO). Identification of suitable candidates for this invasive treatment needs to be determined. |
