Context: Five percent of liver transplant recipients require retransplantation within the first year. In light of the critical donor shortage, a critical analysis of risk factors for retransplantation is necessary to reduce this rate.

Objective: The objective was to examine the retransplantation rates at differing time periods following liver transplantation to isolate high-risk periods. A further objective was to compare risk factors for retransplantation at these high-risk time periods.

Methods: We performed a retrospective analysis of UNOS de-identified patient-level data of adult liver transplant recipients between January 1, 2002 and October 31, 2011. We analyzed 49,288 recipients. The primary outcome measure was retransplantation at 7 days, 30 days, and 365 days following liver transplantation. Multivariate logistic regression (stepwise backward) was performed.

Results: The highest retransplantation rate was during the first week (1.0%). The first month had the highest retransplantation rate by month (2.3%). The first year had the highest mortality rate by year (5.4%). Figure 1 and 2 report the significant donor and recipient risk factors for 1 day, 1 month, and 1 year mortality. The strongest risk factors for retransplantation within one day was cold ischemia time over 16 hours (OR 3.6 CI 2.4-5.5); within 1 month was split donor allograft (OR 2.9 CI 1.2-7.1); and within 1 year was donation after cardiac death (OR 4.9 CI 3.6-6.6).

Conclusion: The high-risk periods for retransplantation are during the first week, first month, and first year following liver transplantation. Each high-risk period has common and distinct risk factors for retransplantation. Prolonged cold ishemia time, split donor allograft, and donation after cardiac death were prominent risk factors.

« Back to 2013 American Transplant Congress