Mortality and Morbidity Among Adult Liver Retransplant Recipients

Background: Liver transplantation (LT) is life-saving procedure for patients with end-stage liver failure with up to 20% of patients suffering graft failure following primary transplantation. Retransplantation (ReLT) remains the only definitive treatment for irreversible graft failure. Aims: We aimed to explore the postoperative outcomes following liver ReLT. Methods: Patients who had received a liver transplant between 2003 and 2016 were retrospectively identified using the Scientific Registry of Transplant Recipients (SRTRs). Patients were stratified based on previous liver transplant history. The primary outcomes of this study were 5-year postoperative mortality, morbidity, and length of hospital stay following LT. Results: 60,554 (96%) recipients were first LT recipients and 2524 (4%) were ReLT recipients. Compared with first LT, ReLT recipients had significantly higher rates of mortality (OR 1.93, 95%CI 1.76–2.12), overall morbidity (OR 1.80, 95%CI 1.65–1.96), and prolonged length of stay (OR 1.66, 95%CI 1.52–1.81) on multivariate analysis. Morbidity including cardiovascular (CVD) complications (OR 1.32, 95%CI 1.08–1.60), graft failure (OR 2.18, 95%CI 1.84–2.57), infection (OR 2.13, 95%CI 1.82–2.50), and hemorrhage (OR 2.67, 95%CI 2.00–3.61) were significantly greater in ReLT recipients. Compared to first LT, ReLT patients had a significant increase in overall 5-year mortality (p < 0.001), 5-year mortality due to CVD complications (p < 0.001), infection (p = 0.009), but not graft failure (p = 0.3543). Conclusion: ReLT is associated with higher rates of 5-year mortality, overall morbidity, CVD morbidity, infection, and graft failure. Higher 5-year mortality in ReLT is due to CVD and infections. These results could be used in preoperative patient assessment and prognostic counseling for ReLT. Graphical Abstract: [Figure not available: see fulltext.].