Long-term outcomes of retransplantation after live donor liver transplantation: A Western experience |
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| Affiliation: | 1. Multi Organ Transplant Program, University Health Network, Toronto, Canada;2. Department of Surgery, Henry Ford Hospital, Detroit, MI;3. Department of Surgical Sciences, Akademiska sjukhuset, Uppsala University, Sweden;4. Division of Transplantation, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH;5. Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX;6. Division of Hepatopancreatobiliary and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, University Medical Centre Rotterdam, the Netherlands;7. Division of General Surgery, Toronto General Hospital, University of Toronto, Canada;8. Division of Gastroenterology, Department of Medicine, University of Toronto, Canada;9. Toronto General Hospital Research Institute, Toronto, Canada;10. Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Canada |
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| Abstract: | BackgroundDespite most liver transplants in North America being from deceased donors, the number of living donor liver transplants has increased over the last decade. Although outcomes of liver retransplantation after deceased donor liver transplantation have been widely published, outcomes of retransplant after living donor liver transplant need to be further elucidated.MethodWe aimed to compare waitlist outcomes and survival post-retransplant in recipients of initial living or deceased donor grafts. Adult liver recipients relisted at University Health Network between April 2000 and October 2020 were retrospectively identified and grouped according to their initial graft: living donor liver transplants or deceased donor liver transplant. A competing risk multivariable model evaluated the association between graft type at first transplant and outcomes after relisting. Survival after retransplant waitlisting (intention-to-treat) and after retransplant (per protocol) were also assessed. Multivariable Cox regression evaluated the effect of initial graft type on survival after retransplant.ResultsA total of 201 recipients were relisted (living donor liver transplants, n = 67; donor liver transplants, n = 134) and 114 underwent retransplant (living donor liver transplants, n = 48; deceased donor liver transplants, n = 66). The waitlist mortality with an initial living donor liver transplant was not significantly different (hazard ratio = 0.51; 95% confidence interval, 0.23–1.10; P = .08). Both unadjusted and adjusted graft loss risks were similar post-retransplant. The risk-adjusted overall intention-to-treat survival after relisting (hazard ratio = 0.76; 95% confidence interval, 0.44–1.32; P = .30) and per protocol survival after retransplant (hazard ratio:1.51; 95% confidence interval, 0.54–4.19; P = .40) were equivalent in those who initially received a living donor liver transplant.ConclusionPatients requiring relisting and retransplant after either living donor liver transplants or deceased donor liver transplantation experience similar waitlist and survival outcomes. |
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