1. The Evolution of Redo Liver Transplantation Over 35 Years: Analysis of 654 Consecutive Adult Liver Retransplants at a Single Center.
- Author
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Kaldas, Fady M., Horwitz, Julian K., Noguchi, Daisuke, Korayem, Islam M., Markovic, Daniela, Ebaid, Samer, Agopian, Vatche G., Yersiz, Hasan, Saab, Sammy, Han, Steven B., El Kabany, Mohamad M., Choi, Gina, Shetty, Akshay, Singh, Jasleen, Wray, Christopher, Barjaktarvic, Igor, Farmer, Douglas G., and Busuttil, Ronald W.
- 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. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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