Patient survival following third time liver transplant in the United States in the MELD era.

Background: Third time liver transplantation is a technically demanding exercise with variable outcomes in single center series. There has been no national level description of survival following third time liver transplant in the US in the MELD era.
Methods: Third time liver transplants between March 1, 2002 and January 1, 2018 in the UNOS dataset were analyzed.
Results: Patient survival among the 240 third time liver transplant recipients in the study at 1, 3, 5, and 10 years (71.8%, 62.4%, 59.1%, 49.5%) was significantly worse compared to primary liver transplant (90.6%, 83.9%, 78.8%, 67.6%; p < 0.001) and retransplant (77.1%, 70.3%, 65.6%, 54.9%; p = 0.014). Recipients who were under 43 years old, not on dialysis, without diabetes, and over 1 month out from their second transplant had acceptable survival at 1, 3, 5, and 10 years (88.5%, 78.4%, 73.6%, 69.7%).
Conclusions: While redo-redo transplant remains a challenging endeavor, appropriate patient selection can yield acceptable results.
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