Many centers consider liver retransplantation controversial due to poor outcomes and high resource requirement. In the setting of renal failure and high MELD, many are denied retransplant. Our protocol involves an aggressive approach to retransplant, with careful patient selection, appropriate donor matching, liberal use of intraoperative dialysis, and three staff surgeons in the OR.

Our aim is to evaluate our recent outcomes of liver retransplantation (RedoLT) compared to primary transplant (1[ordm]LT).

We reviewed 1012 records of patients undergoing LT between 2012 and 2017. Fifty-three were RedoLT (5.2%). Combined liver-kidney (CLK) transplants were a significant subset of both primary(13%) and retransplants(28%). Retransplant diagnosis included primary disease recurrence,47.2%; chronic rejection,17%; vascular thrombosis,17%; PNF,11.3% and ischemic cholangiopathy,7.5%.

Recipient age and cold ischemia time were similar in all groups. MELD-Na was significantly higher in both retransplant groups compared to primary transplants. Donor risk index was lower in 1[ordm]CLK than 1[ordm]LT, with no difference in 1[ordm] and Redo groups.

1[ordm]LT and RedoLT had similar 1 and 3 year patient (93.1, 86.8% vs 94.7, 82.8%) and graft survival (90.7, 84.5% vs 92.1, 80%). 1[ordm]CLK and RedoCLK had similar 1 and 3 year patient (93.4, 87.1% vs 86.2, 86.2%) and graft survival (93.4, 87.1% vs 93.4, 87.1%). Transfusions, OR duration and hospital length of stay were increased in both RedoLT and RedoCLK.

In our series, survival after liver retransplant is excellent and is similar to primary liver transplant, despite inherent increased complexity and higher MELD than primary transplants. More resources are utilized in the redo setting. CLK transplant in the redo setting achieved satisfactory outcomes in a group often considered prohibitive.

CITATION INFORMATION: Sonnier D., Bruce D., Bohorquez H., Bugeaud E., Carmody I., Cohen A., Mathur A., Seal J., Loss G. Outcomes in Liver and Combined Liver-Kidney Retransplantation Am J Transplant. 2017;17 (suppl 3).

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