*Purpose: Given the increase in demand for donor livers, it has become more critical than ever to predict mortality in order to identify the best possible use of a donor organ. This is particularly true in cases involving retransplantation, which is increasing in prevalence despite overall poorer outcomes. Our aim was to develop a predictive index for liver retransplantation to predict mortality based on donor and recipient characteristics.

*Methods: Using the OPTN database, we performed univariate and multivariate analysis on 5,183 liver retransplantations to identify independent donor and recipient risk and protective factors for post-transplant mortality. This retrospective analysis was used to create a weighted score that can be used to predict post-retransplant mortality.

*Results: We found 14 factors to be significant and weighted them according to their odds ratio to generate an r-SOFT (Retransplant Survival Outcomes following Liver Transplantation) score with a C-statistic of 0.705. We then generated a Kaplan-Meier curve to estimate survival at ten years post-retransplant, stratifying patients into low-, moderate-, and high-risk groups by tertile. The most significant risk factors for post-transplant mortality were hemodialysis prior to transplant and poor functional status, while the most significant protective factors were a short cold ischemia time and recipient age below 30.

*Conclusions: This scoring system can be used to predict mortality post-transplant for patients who have already received a liver transplant. It uses criteria from both the donor and the recipient in order to aid decision-making for patients requiring a second liver and identify transplant patients at particularly high risk.

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