*Purpose: Donation after circulatory death (DCD) liver transplant (LT) recipients have a higher likelihood of delayed graft loss due to Ischemic cholangiopathy (IC). Limited data exist regarding outcomes following re-transplantation (re-LT) after primary DCD LT. Our aim was to evaluate outcomes following re-LT for delayed graft loss in recipients of DCD LT, identify predictors of outcome and trends over time.

*Methods: Using SRTR, retrospective study cohorts were constructed of recipients undergoing re-LT ≥ 30 days following primary LT using either Donation after brain death (DBD) or DCD grafts, between 2005-2020, divided into 3 eras: era 1: 2005-2009; era 2: 2010-2014; era 3: 2015-2020. The 30-day time frame was chosen to evaluate impact of longer term graft failure from IC. Primary outcome measures were graft (GS) and patient survival (PS). A chi-square test was used for categorical and Student’s t-test for continuous variables. Survival comparison was performed using the Kaplan-Meier method with log-rank test and multivariable analysis of outcomes using Cox proportional hazard models.

*Results: 1681 patients underwent re-LT over the study period: 270 and 1411 respectively were recipients of DCD (DCD-re-Tx) and DBD (DBD-re-Tx) grafts in primary LT. Proportion of DCD-re-Tx remained steady over the study period, ranging from 15% of all re-Tx in era 1 to 19.3% in era 3. DCD-re-LT recipients were more likely be older, male with lower MELD score at re-Tx (22.3 ± vs. 25.9; p<.0001). GS in DCD-re-Tx and DBD-re-Tx were comparable at all time points studied (Fig 1). PS was also comparable: 1 Yr: 81.9 vs. 78; 3 Yr: 74.3 vs. 68.9; 5 Yr: 69.7 vs. 64.2 (p=0.07). GS and PS following DCD-re-LT improved significantly over time. Era 1 vs. era 2 vs. era 3: One-year GS: 67.4 vs. 81.1 vs. 85.6% (p=0.03) and one-year PS: 75 vs. 83.8 vs. 87.6% (p=0.03). On multivariable analysis, recipient, donor age and recipient BMI, but not graft type at primary LT (HR (95% CI): 1.19 (0.96 - 1.49), p=0.12) were predictive of GS and PS following liver re-Tx.

*Conclusions: In patients undergoing re-LT for delayed graft loss, outcomes of prior recipients of DCD grafts were comparable to DBD recipients and improved over time. With improving outcomes following primary DCD-LT, our observation should encourage ongoing efforts to optimize utilization of DCD grafts in the context of continued deceased donor organ shortage.

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