Introduction:A significant proportion of liver transplant recipients will suffer from graft loss, after which liver retransplant (reLTx) becomes their only therapeutic option. Patients with very high MELD scores fare the worst without reLTx and may have the most to benefit from such intervention, these patients who start at a sicker baseline don't fare as well clinically, often consuming more healthcare resources. Existing literature on high MELD and futility often excludes reLTx patients from the sample.

Materials and Methods: We studied outcomes in patients with MELD≥40 undergoing reLTx using UNOS data from 2002 to 2011. A subgroup analysis of patients who died within 3 months of reLTx was also performed to identify predictors of futile intervention. Outcomes of interest were graft and patient survival at 1, 3, 12, 36, and 60 months.

Results:Kaplan-Meier survival estimates at 1, 3, 12, 36 and 60 months were 73.6%, 64.9%, 57%, 49%, and 46% for the grafts and 76%, 69%, 61%, 54%, and 51% for the patients. A Cox-survival analysis identified predictors of mortality, including: higher donor and recipient age, ECD donor type, warm ischemic time, and livers from national share. Predictors of futility were female sex, ICU stay, ionotropic use, and mechanical ventilation.

Conclusion: The five year patient survival of >50% indicates the overall appropriateness of re transplantation in this cohort. Predictors of futility and failure may allow clinicians to provide improved informed consent and maximize outcomes.

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