Liver Retransplantation: The Largest Post MELD Single Center Experience.

F. Kaldas, I. Korayem, V. Agopian, T. Russell, S. Ebaid, A. Zarrinpar, H. Yersiz, D. Farmer, R. Busuttil.

Surgery, University of California Los Angeles, Los Angeles, CA

Meeting: 2017 American Transplant Congress

Abstract number: 247

Keywords: Liver, Liver failure, Liver transplantation, Retransplantation

Session Information

Session Name: Concurrent Session: Liver Retransplantation and Other Complications

Session Type: Concurrent Session

Date: Monday, May 1, 2017

Session Time: 2:30pm-4:00pm

Presentation Time: 2:30pm-2:42pm

Location: E353B

OBJECTIVE: Analyze post MELD liver retransplantation (Re-OLT) and identify recipient and donor preoperative risk factors associated with poor patient outcomes.

BACKGROUND: Re-OLT is a high risk operation for patients with failed liver allografts. The use of the MELD system for organ allocation coupled with organ scarcity have increased patient acuity and emphasized the need to avoid futility.

PATIENTS AND METHODS: Multivariate logistic regression assessed recipient, donor, and perioperative factors at a single academic center. Cox proportional hazard regression assessed the impact of each significant variable (198 adults, Re-OLT 2/2002-9/2015, minimum follow-up 1 year)

RESULTS: Overall 1, 3, 5 and 10-year survival was 68.7%, 60.4%%, 55.7% and 37.4% respectively. The most common indications for Re-OLT were recurrence of primary disease (51, 25.8%), anatomical (vascular and biliary) causes (50, 25.3%), primary graft non-function (36 (18.2%). The most common causes of mortality were sepsis and MSOF (50%), graft failure (18%) and respiratory failure (6%). The highest rate of mortality occurred within the first-year post Re-OLT (31.3%).Predictors of 1-year mortality were analyzed using multivariate and cox regression analysis as shown below.

	OR	P-value (OR)	HR	P-value (HR)
≥2 vasopressor agents	6.423	0.022*	4.794	0.001*
D-MELD ≥1750	4.549	0.003*	3.467	0.001*
Waitlist time <80 days	3.841	0.047*	3.516	0.037*
Recipient age ≥50y	3.074	0.010*	2.633	0.007*
Retransplantation due to anatomical problems	2.930	0.011*	2.385	0.004*
Preoperative hospitalization >30 days	2.383	0.043*	2.133	0.022*

The effect of each of the identified predictors on survival within 1-year post Re-OLT is illustrated in figure below CONCLUSIONS:

Outcomes of Re-OLT can be improved by careful patient selection and meticulous perioperative management.

CITATION INFORMATION: Kaldas F, Korayem I, Agopian V, Russell T, Ebaid S, Zarrinpar A, Yersiz H, Farmer D, Busuttil R. Liver Retransplantation: The Largest Post MELD Single Center Experience. Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Kaldas F, Korayem I, Agopian V, Russell T, Ebaid S, Zarrinpar A, Yersiz H, Farmer D, Busuttil R. Liver Retransplantation: The Largest Post MELD Single Center Experience. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/liver-retransplantation-the-largest-post-meld-single-center-experience/. Accessed November 22, 2024.

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