*Purpose: Liver retransplantation (re-OLT) represents a high risk, resource intense, operation for recipients with failed allografts. We review our single center 22-year experience with re-OLT to identify patients undergoing Interventional Radiology (IR) procedures in the setting of complicated re-OLT.

*Methods: A retrospective case study was conducted of all patients undergoing re-OLT at our center from 1998-2020. Subgroup analysis was performed on all patients undergoing IR procedures in the setting of complicated re-OLT.

*Results: 295 consecutive re-OLT were performed from 1998 – 2020; 261 patients were second re-OLT, 27 cases were third re-OLT, 7 patients received a fourth or higher re-OLT. The most prevalent index causes of liver failure included Hepatitis C (122, 45.5%), Alcohol (34, 12.5%), and Primary Sclerosing Cholangitis (28, 10.4%). Most index transplants were whole liver allografts (239, 96%) from donation after brain death (DBD) donors (205, 83.0%). Median graft survival after first transplant 131.5 days (range 1 – 5935 days). The primary diagnoses necessitating re-OLT included recurrent liver disease (74, 29.8%), ischemic cholangiopathy (34, 13.7%), and hepatic artery thrombosis (26, 10.5%).

Subgroup analysis was performed on 82 (34.7%) second re-OLT recipients requiring IR treatment of post-transplant complications. Primary causes of liver failure in this subgroup mirrored the general population including: Hepatitis C (31, 37.8%), Alcohol (11, 13.4%), and PSC (10, 12.2%). These recipients received primarily whole liver (79, 86.3%) DBD (69, 85.2%) allografts. Median graft survival after first transplant and IR intervention was 224 days (range 3-557 days). Primary re-OLT indications in this subgroup reflected technical and graft related complications including Hepatic Artery Thrombosis (16, 19.5%), ischemic cholangiopathy (14, 17.1%), and Chronic Rejection (8, 9.8%). Interventional radiology procedures performed included: biliary stent (3, 3.7%), drainage of biloma (6, 7.3%), hepatic artery intervention (32, 39.0%), hepatic venous outflow procedure (25, 30.5%), portal vein intervention (3, 3.7%), and other (19, 23.2%).

5 patients undergoing third re-OLT required IR procedures post-transplant. 3 patients undergoing fourth or higher re-OLT had post-transplant IR procedures.

*Conclusions: IR procedures offer a safe treatment strategy for post-transplant complications in re-OLT recipients with similar post-intervention survival.

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