Background: Liver retransplantation (re-LT) accounts for up to 22% after primary liver transplantation (LT), and using donor livers for retransplantation can only be justified by successful outcomes. Methods: A total of 2,387 adult recipients with 2,778 LT, between 1979 and 2017, were analyzed to determine risk factors and outcome of re-LT in the Netherlands. Results: Of 2,778 LT, 336 (12.1%) were first, 43 (1.5%) were second, and 12 (0.5%) were third or fourth re-LT. The 5-year patient survival for primary LT, and first, second, and third or fourth re-LT were 74.0%, 70.8%, 63.3%, and 57.1%, respectively (P = 0.10). Recipient age (≤60 years) (OR 1.96, P < 0.001), era (1979–2006) (OR 1.56, P = 0.003), donor after circulatory death (DCD) (OR 1.96, P < 0.001), and cold ischemia time (CIT) (>9 h) (OR 1.42, P = 0.007) were significant risk factors for retransplantation after primary LT. Conclusions: Recipient age, era, DCD, and prolonged CIT were identified as parameters for retransplantation. The outcome after the first re-LT was good, and comparable to those of primary transplants. Survival after multiple re-LT was not significantly different from the first retransplant group, legitimizing third and fourth re-LT to well-selected patients.

Liver retransplantation, Outcome,
Journal of Hepato-Biliary-Pancreatic Sciences
Department of Surgery

Takagi, K, Domagala, P. (Piotr), Porte, R.J, Alwayn, I.P.J, Metselaar, H.J, van den Berg, A.P. (Aad P.), … Polak, W.G. (2019). Liver retransplantation in adult recipients: analysis of a 38-year experience in the Netherlands. Journal of Hepato-Biliary-Pancreatic Sciences, 27(1), 26–33. doi:10.1002/jhbp.701