The Evolution of Redo Liver Transplantation Over 35 Years: Analysis of 654 Consecutive Adult Liver Retransplants at a Single Center - PubMed (original) (raw)

. 2023 Sep 1;278(3):441-451.

doi: 10.1097/SLA.0000000000005962. Epub 2023 Jun 26.

Julian K Horwitz 1, Daisuke Noguchi 1, Islam M Korayem 1, Daniela Markovic 2, Samer Ebaid 1, Vatche G Agopian 1, Hasan Yersiz 1, Sammy Saab 3, Steven B Han 3, Mohamad M El Kabany 3, Gina Choi 3, Akshay Shetty 3, Jasleen Singh 3, Christopher Wray 4, Igor Barjaktarvic 5, Douglas G Farmer 1, Ronald W Busuttil 1

Affiliations

The Evolution of Redo Liver Transplantation Over 35 Years: Analysis of 654 Consecutive Adult Liver Retransplants at a Single Center

Fady M Kaldas et al. Ann Surg. 2023.

Abstract

Objective: To examine liver retransplantation (ReLT) over 35 years at a single center.

Background: Despite the durability of liver transplantation (LT), graft failure affects up to 40% of LT recipients.

Methods: All adult ReLTs from 1984 to 2021 were analyzed. Comparisons were made between ReLTs in the pre versus post-model for end-stage liver disease (MELD) eras and between ReLTs and primary-LTs in the modern era. Multivariate analysis was used for prognostic modeling.

Results: Six hundred fifty-four ReLTs were performed in 590 recipients. There were 372 pre-MELD ReLTs and 282 post-MELD ReLTs. Of the ReLT recipients, 89% had one previous LT, whereas 11% had ≥2. Primary nonfunction was the most common indication in the pre-MELD era (33%) versus recurrent disease (24%) in the post-MELD era. Post-MELD ReLT recipients were older (53 vs 48, P = 0.001), had higher MELD scores (35 vs 31, P = 0.01), and had more comorbidities. However, post-MELD ReLT patients had superior 1, 5, and 10-year survival compared with pre-MELD ReLT (75%, 60%, and 43% vs 53%, 43%, and 35%, respectively, P < 0.001) and lower in-hospital mortality and rejection rates. Notably, in the post-MELD era, the MELD score did not affect survival. We identified the following risk factors for early mortality (≤12 months after ReLT): coronary artery disease, obesity, ventilatory support, older recipient age, and longer pre-ReLT hospital stay.

Conclusions: This represents the largest single-center ReLT report to date. Despite the increased acuity and complexity of ReLT patients, post-MELD era outcomes have improved. With careful patient selection, these results support the efficacy and survival benefit of ReLT in an acuity-based allocation environment.

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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Conflict of interest statement

The authors report no conflicts of interest.

References

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