Introduction: Retransplantation with a third liver allograft is controversial with significant technical and medical challenges. National outcomes have not been described. We hypothesize that prior LTx survival will influence third LTx survival. Methods: National data from the United Network for Organ Sharing (UNOS) were used to assess characteristics of first, second and third LTxs among patients transplanted from October 1987 to March 2016. Survival analysis of time to death or retransplantation using Kaplan-Meier product limit estimates and a multivariable Cox proportional hazards model to determine factors associated with graft failure were performed. Results: Our study included 8,499 second and 732 third LTx recipients. Median composite survival times for first, second, and third grafts were 10.9, 5.7, and 2.2 years, respectively. Second and third LTx recipients were more likely to be younger (mean age: LTx1 52.3, LTx2 49.2, LTx3 45.5 years; p<0.01), to be receiving care in an intensive care unit at the time of transplant (LTx1 14.5%, LTx2 45.7%, LTx3 48.8%; p<0.01), and to have a higher MELD score (LTx1 21.5, LTx2 26.8, LTx3 28.6; p<0.01). When stratified by second LTx graft survival, third LTx graft survival was significantly lower when interval from second LTx was <1 week, 1 week -1 month, and <1 year, versus 1-5 ears and >5 years (log-rank p<0.01). Conclusion: Patients receiving a third LTx have decreased composite graft survival compared to first or second LTxs. However, third grafts are likely to last longer if the second LTx graft survival was greater than 1 year.

CITATION INFORMATION: Barry M, Gupta M, Goldberg D, Levine M, Simpson D, Olthoff K, Shaked A, Abt P. Third Liver Transplantation, Outcomes, and the Impact of Previous Graft Survival. Am J Transplant. 2017;17 (suppl 3).

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