Outcomes of Adult Liver Retransplantation: A Canadian National Database Analysis

Abstract

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.

Liver Retransplantation: Prognostic Scores and Results in the State of Paraná

“…Several authors demonstrated a poorer prognosis for retransplantation compared to primary transplantation. Berumen et al reported 83.0, 75.0, and 69.0% survival rates at one, three, and five years on primary transplants, respectively, and 67.0, 60.0, and 53.0% on retransplants 4 , Yoon et al showed 91.4, 86.0, 81.8, and 72.9% survival rates at one, three, five, and ten years on primary transplants, respectively, and 77.1, 70.4, 65.5, and 60.0% on retransplantations 31 . Masior et al reported a retransplantation survival of 69.9% in the immediate postoperative period 20 .…”

“…In the present study, 6.4% of all liver transplants performed in the state of Paraná, required retransplantation, consistent with findings reported in other countries. Alamo et al related retransplantation incidences ranging from 6.0 to 11.0% 1 , and Yoon et al indicated a range of 5.5 to 7.0% 31 . In Canada, the rate was 6.5% 31 ; in Poland, 6.3% 20 ; in Germany, 9.2% 17 ; in China, 4.3% 9 ; and in Spain, rates varied between 6.3 26 , 8.4 3 , and 6.6% 1 .…”

“…Alamo et al related retransplantation incidences ranging from 6.0 to 11.0% 1 , and Yoon et al indicated a range of 5.5 to 7.0% 31 . In Canada, the rate was 6.5% 31 ; in Poland, 6.3% 20 ; in Germany, 9.2% 17 ; in China, 4.3% 9 ; and in Spain, rates varied between 6.3 26 , 8.4 3 , and 6.6% 1 .…”

The Evolution of Redo Liver Transplantation Over 35 years

“…Concerns over historically poor outcomes relative to primary LT, as well as unique technical challenges in ReLT, have led to the procedure being performed relatively infrequently, currently accounting for only 4.3% of annual LTs in the United States. 4,[9][10][11][12][13][14] Indeed, the ethical considerations of utilitarian allocation of scarce liver allografts have placed significant emphasis on highly selective ReLT candidate selection to avoid futile outcomes. 15 Accordingly, over the past few decades, several efforts have been made to identify risk factors correlated with poor ReLT outcomes 5,6,12,[16][17][18][19] commonly, including the model for end-stage liver disease (MELD) score, which has not been shown to be an accurate predictor of postoperative outcomes after primary-LT. 20,21 In the current era of LT defined by high-acuity and high-MELD recipients, 22 there is a critical need to reassess ReLT outcomes.…”

“…Despite the observed prevalence of long-term graft failure, only 5% to 15% of LT recipients ultimately undergo ReLT, 1,9–12 highlighting ongoing issues with access to ReLT. Concerns over historically poor outcomes relative to primary LT, as well as unique technical challenges in ReLT, have led to the procedure being performed relatively infrequently, currently accounting for only 4.3% of annual LTs in the United States 4,9–14 . Indeed, the ethical considerations of utilitarian allocation of scarce liver allografts have placed significant emphasis on highly selective ReLT candidate selection to avoid futile outcomes 15 .…”