Conflict of interest: None of the authors has any conflict of interests to disclose. Martin Montenovo, the principal author, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Outcomes of adult liver re-transplant patients in the model for end-stage liver disease era: is it time to reconsider its indications?
Article first published online: 11 AUG 2014
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Volume 28, Issue 10, pages 1099–1104, October 2014
How to Cite
Outcomes of adult liver re-transplant patients in the model for end-stage liver disease era: is it time to reconsider its indications?, , .
- Issue published online: 18 OCT 2014
- Article first published online: 11 AUG 2014
- Accepted manuscript online: 17 JUL 2014 02:49AM EST
- Manuscript Accepted: 13 JUL 2014
- AHRQ. Grant Number: K12HS021686
- Health Resources and Services Administration. Grant Number: 234-2005-37011C
- liver re-transplantation;
- patient and graft survival
To better understand the outcomes and utility of liver re-transplantation in non-hepatitis C patients, we sought to identify predictors that impact post-transplant patient and graft survival comparing primary liver transplant patients to those receiving subsequent allografts.
We conducted a retrospective cohort analysis using the United Network for Organ Sharing database from February 2002 through December 2012, including non-hepatitis C infected adults (18 yr and older) who underwent primary and repeat liver transplantation. Patient and graft survival were compared between the two groups using the Kaplan–Meier estimator. Cox proportional hazards models were constructed to evaluate variables associated with both patient and graft survival.
We identified 33 176 primary transplant recipients and 2710 re-transplants. Re-transplantation patients were more likely to be on dialysis prior to transplant (18% vs. 10%), hospitalized (26% vs. 16%), in the intensive care unit (ICU) (34% vs. 13%), on a ventilator (17% vs. 3%), and had higher model for end-stage liver disease (MELD) score (27 vs. 21). Re-transplants also received livers with a lower donor risk index (DRI) (1.57 vs. 1.64). We estimated an adjusted hazard ratio (HR) of 1.7 for patient survival (95% CI: 1.56–1.84) and 1.61 (95% CI: 1.5–1.73) for graft survival.
Liver re-transplantation in non-hepatitis C patients, although life saving, has significantly inferior patient and graft survival compared to primary liver transplantation. Higher quality grafts are used inefficiently in a sicker patient population, suggesting that a more optimal strategy may include restricting their use to patients who obtain a longer term benefit.