*Purpose: Scarcity of donor organs in liver transplantation (LT) has necessitated consideration of donation after circulatory death (DCD) donors. Complications following LT and disease recurrence are common causes of graft failure, necessitating consideration of liver re-transplantation (re-LT). However, re-LT remains controversial due to inferior outcomes compared to primary LT. There is very limited data regarding the role of DCD grafts in tre-LT. Our aim was to compare the outcome of patients undergoing liver re-LT using DCD with donation after brain death (DBD) grafts and determine predictors of outcome.

*Methods: Using data from SRTR, a retrospective cohort was constructed of recipients who underwent liver re-LT over a 15 year period (Jan 2005 – Aug 2019). Those undergoing DCD re-LT were compared to DBD re-LT. Simultaneous liver-kidney recipients were excluded. Primary outcome measures evaluated were graft and patient survival. Graft failure was defined as the earlier of re-LT or death. Variables analyzed included donor and recipient age, gender, race, BMI, donor cause of death, warm and cold ischemia time, etiology of liver failure, MELD score at transplant. Chi square test was used for categorical variables and students t-test for continuous variables. Survival comparison was performed using Kaplan-Meier method (SAS ver. 9.0). Cox multivariable regression analysis was utilized to determine predictors of outcome following DCD re-LT.

*Results: 4542 transplants were performed over the study period using DCD grafts, representing 5.8% of all LT. 2813 patients underwent liver re-LT over the study period comprising 3.6% of all LT, of which 45 (1.6%) received DCD grafts. Five DCD re-LT recipients had received a DCD graft for primary LT as well. Recipients in both groups were comparable with respect to all examined variables. Donor variables were also comparable except for mean donor age (36.7 vs. 33.4%; p=0.007), which was higher in the DBD group. One year graft survival was lower in the DCD group (60.7% vs. 73.5%; p=0.03). However, graft survival at 3 years (50.4% vs. 65.2%; p = 0.48) and patient survival at 1 & 3 years in both groups were similar (71.5% vs. 76.6%, p=0.54; 63.7% vs. 69.14%, p=0.61 respectively). Multivariable analysis identified recipient and donor age, male gender and non-Caucasian ethnicity as independent predictors of graft and patient survival after DCD liver re-LT.

*Conclusions: Even though 1-year graft survival is inferior in DCD re-LT, 3 year graft survival and 1- and 3- year patient survival are similar to DBD recipients. Predictors of graft and patient survival following DCD re-LT are similar to those undergoing primary DCD LT. DCD grafts could therefore be selectively considered for liver re-LT and could enable expansion of the donor pool for this subset without compromising patient survival as well as access to DBD grafts for primary LT.

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