Excellent Contemporary Graft Survival for Adult Liver Retransplantation: An Australian and New Zealand Registry Analysis From 1986 to 2017

Jeffrey, Angus W; Delrivière, Luc; McCaughan, Geoffrey W.; Crawford, Michael; Angus, Peter W; Jones, Robert; Macdonald, Graeme A.; Fawcett, Jonathan; Wigg, Alan; Chen, John; Gane, Ed; Munn, Stephen; Jeffrey, Gary P.

doi:10.1097/txd.0000000000000920

Cited by 20 publications

(19 citation statements)

References 16 publications

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“…Temporally, we noted that the frequency of retransplantation has steadily increased in Canada from 9 cases in 2000 to 31 cases in 2018, with approximately 0.2% yearly increase in retransplantation rates. Similarly, Australia and New Zealand have also noticed an increase in retransplantation since 2001 [ 13 ]. Conversely, this has not been the case in Europe, where an analysis of the European Liver Transplant Registry (ELTR) from 2000–2009 revealed a 5% decrease in the utilization of retransplantation [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Adult Liver Retransplantation: A Canadian National Database Analysis

Yoon

Patel

Perez

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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Background. Liver retransplantation remains as the only treatment for graft failure. This investigation aims to assess the incidence, post‐transplant outcomes, and risk factors in liver retransplantation recipients in Canada. Materials and Methods. The Canadian Organ Replacement Register was used to obtain and analyse data on all adult liver retransplant recipients, matched donors, transplant-specific variables, and post‐transplant outcomes from January 2000 to December 2018. Results. 377 (6.5%) patients underwent liver retransplantation. Autoimmune liver disease and hepatitis C virus (HCV) were the most common underlying diagnoses. Graft failure was 7.9% and 12.5%, and overall survival was 77.1% and 65.6% at 1 year and 5 years, respectively. In contrast to recipients receiving their first graft transplant, the retransplantation group had a significantly higher incidence of graft failure p < 0.001 and lower overall survival p < 0.001 . The graft failure and patient survival rates were comparable between second transplant and repeat retransplant recipients. Furthermore, there were no differences in graft failure and patient survival when stratified according to time to retransplantation. Recipient and donor age (HR = 1.12, p = 0.011 ; HR = 1.09, p = 0.008 ), recipient HCV status (HR = 1.81, p = 0.014 ), and donor cytomegalovirus status (HR = 4.10, p = 0.006 ) were predictors of patient mortality. Conclusion. This analysis of liver retransplantation demonstrates that this is a safe treatment for early and late graft failure. Furthermore, even in patients requiring more than two grafts, similar outcomes to initial retransplantation can be achieved with careful selection.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Adult Liver Retransplantation: A Canadian National Database Analysis

Yoon

Patel

Perez

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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“…5 Decompensated cirrhosis (DC) patients often require nutritional support but optimal timing of intervention and outcomes are unclear. 6 1). Prevalence of malnutrition was 76.6% (CI 62-87.6%) which was independent of age or aetiology of liver disease but was associated with disease severity.…”

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confidence: 99%

“…Graft failure occurs in 5-22% of all liver transplant recipients. [1][2][3][4][5][6] Liver re-transplantation has been considered controversial, with clinical, economic, and ethical considerations. A study from Birmingham in 2009, reported no survival benefit following second and third re-transplantation.…”

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confidence: 99%

P046 Liver re-transplantation in adults; a single UK centre experience (2009–2020)

Morgan

Mahgoub

Tripathi

et al. 2021

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Engagement was measured as the proportion of actual ultrasound attendances versus number of expected ultrasound attendances. Descriptive analysis was done with SPSS version 27. Results Our cohort was comprised of 45 patients (mean follow up of 2.34 years (SD±357 days)). In the more deprived 50% of the cohort there were significantly more males X 2 ((1, N= 45)=4.60 p=0.39), other baseline characteristics are reported in table 1. The median cumulative rate of actual versus expected surveillance events across the cohort was 0.67(0.40, 1.00). Figure 1 shows there was no significant difference in engagement between the less deprived groups (0.63 vs. 0.63; p=0.83). There was no significant association between outcomes dependant on IMD, 33/45 patients are under continued follow up, shown in chart 1. Conclusion Engagement at this service is equivalent irrespective of IMD. Attendance rates at this service are comparable with the literature, demonstrating this services' ability to overcome barriers such as deprivation.

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“…Notably, patients with POPH had significantly lower MELD scores at the time of LT, were more likely to be female, had higher pretransplant serum albumin and sodium, and had a higher functional capacity at the time of LT, all of which would be expected to protect against graft failure, and therefore the increased risk of graft failure in patients with POPH is even more striking. (29)(30)(31)(32)(33)(34) Among patients with POPH undergoing LT, we observed a significant association with adverse post-LT outcomes and pre-LT hemodynamics, identifying a pre-LT PVR >1.6 as significantly increasing the risk of post-LT adverse outcomes (death or retransplantation) in patients with POPH. This threshold is lower than expected from similar work recently published by DuBrock et al (20) and Cartin-Ceba et al, (21) who identified a PVR ≥3 WU as predictive for post-LT mortality in patients with POPH and is also lower than the diagnostic criteria currently used to define POPH (MPAP ≥25 mm Hg, PVR ≥3 WU).…”

Section: Discussionmentioning

confidence: 72%

Pulmonary Vascular Resistance Predicts Mortality and Graft Failure in Transplantation Patients With Portopulmonary Hypertension

et al. 2021

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Earn MOC for this article: www.wileyhealthlearning.com/aasld.aspx Portopulmonary hypertension (POPH) is a pulmonary vascular disease associated with significant morbidity and mortality in those with liver disease, conferring a higher mortality in patients awaiting liver transplantation (LT). Although not a transplant indication, patients with POPH can experience significant clinical improvement following LT, and those maintaining a mean pulmonary artery pressure (MPAP) <35mm Hg and a pulmonary vascular resistance (PVR) <5 Woods units (WU) are granted additional listing points to expedite LT. The effect of POPH on posttransplant outcomes such as mortality and graft failure, however, is not well defined. We performed a retrospective cohort study of the US Organ Procurement and Transplantation Network database of all adult patients who underwent LT between January 1, 2006, and December 1, 2020. Using adjusted accelerated failure time models, we examined the relationship between a diagnosis of POPH and outcomes following LT and the relationship between pre-LT hemodynamics and post-LT survival (alive with a functioning graft) in patients with POPH. Compared with those undergoing transplants without exception points, patients with POPH had comparable post-LT survival rates but were significantly more likely to have graft failure. Both pre-LT MPAP and PVR predicted post-LT survival in POPH, with a pre-LT PVR of ≥1.6 WU, more than doubling the hazard for mortality (death or a nonfunctioning graft; coefficient, 2.01; standard error, 0.85; hazard ratio, 2.21; P = 0.02). POPH may confer a significantly higher risk of post-LT graft failure compared with patients with cirrhosis without POPH, and a pre-LT PVR of ≥1.6 WU may predict post-LT survival. Further investigation into the relationship between pre-LT hemodynamics, right ventricular function, and post-LT outcomes of mortality and graft failure in POPH is needed.

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Excellent Contemporary Graft Survival for Adult Liver Retransplantation: An Australian and New Zealand Registry Analysis From 1986 to 2017

Cited by 20 publications

References 16 publications

Outcomes of Adult Liver Retransplantation: A Canadian National Database Analysis

Outcomes of Adult Liver Retransplantation: A Canadian National Database Analysis

P046 Liver re-transplantation in adults; a single UK centre experience (2009–2020)

Pulmonary Vascular Resistance Predicts Mortality and Graft Failure in Transplantation Patients With Portopulmonary Hypertension

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