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High Risk, High Reward: An Analysis Of Outcomes For Candidates Awaiting Hepatic Retransplantation
*Jigesh A. Shah, *Madhukar S. Patel, *Johannes R. Kratz, James F. Markmann, *Parsia A Vagefi
Massachusetts General Hospital/Harvard Medical School, Boston, MA, MA

Objective: Assess the outcomes for candidates listed for hepatic retransplantation.
Design: Single center retrospective study from 1/1/05 to 1/1/13.
Setting: Tertiary care center within UNOS Region 1.
Patients: Adult candidates listed for hepatic retransplantation (n=48).
Interventions: N/A
Main Outcome Measures: Demographics, characteristics, and survival for candidates listed for hepatic retransplantation.
Results: Of the patients listed for retransplant, 1(2%) improved while waiting, 14(29%) died while waiting, and 33(69%) underwent retransplantation. Those retransplanted represented 11% of the total adult liver transplant volume during the same time period. When comparing those who died while waiting to those who were re-transplanted, there was no significant difference in age (47±14 vs. 46±13 years, p=0.73) or MELD at second listing (26±15 vs. 26±11, p=0.99). Waitlisted candidates who failed to achieve retransplant died on average of 50.3±114.5 days after re-listing. Those re-transplanted achieved 3-year survival of 70%. As the average wait time to retransplant was 91±174 days, further comparison between those who were retransplanted within (n=10) and beyond (n=23) 90 days of the first transplant was performed. Although those retransplanted within 90 days were younger (37±12 vs. 54±2, p<.001), the average MELD at second listing was similar (24±12 vs. 27±10, p=0.57) and upon Kaplan-Meyer analysis there was no significant difference in 3-year survival between groups (70% vs. 69.5%, p = 0.28).
Conclusions: Retransplantation of the liver is the only viable option for candidates with nonreversible graft failure, as the inability to achieve retransplantation leads to nearly assured and expeditious death. Furthermore, despite the complexity and technical challenge posed by hepatic re-transplantation, in experienced hands excellent long term survival can be achieved in candidates who experience either early or late primary graft failure.


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