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Novel Benchmark Values for Redo Liver Transplantation Does the Outcome Justify the Effort?
Univ Hosp Zurich, Dept Surg & Transplantat, Zurich, Switzerland..
Univ Hosp Zurich, Dept Surg & Transplantat, Zurich, Switzerland..
Croix Rousse Hosp, Dept Gen Abdominal & Transplant Surg, Lyon, France..
Kings Coll Hosp London, Inst Liver Studies, London, England..
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2022 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 276, no 5, p. 860-867Article in journal (Refereed) Published
Abstract [en]

Objective: To define benchmark cutoffs for redo liver transplantation (redo-LT). Background: In the era of organ shortage, redo-LT is frequently discussed in terms of expected poor outcome and wasteful resources. However, there is a lack of benchmark data to reliably evaluate outcomes after redo-LT. Methods: We collected data on redo-LT between January 2010 and December 2018 from 22 high-volume transplant centers. Benchmark cases were defined as recipients with model of end stage liver disease (MELD) score <= 25, absence of portal vein thrombosis, no mechanical ventilation at the time of surgery, receiving a graft from a donor after brain death. Also, high-urgent priority and early redo-LT including those for primary nonfunction (PNF) or hepatic artery thrombosis were excluded. Benchmark cutoffs were derived from the 75th percentile of the medians of all benchmark centers. Results: Of 1110 redo-LT, 373 (34%) cases qualified as benchmark cases. Among these cases, the rate of postoperative complications until discharge was 76%, and increased up to 87% at 1-year, respectively. One-year overall survival rate was excellent with 90%. Benchmark cutoffs included Comprehensive Complication Index CCI (R) at 1-year of <= 72, and in-hospital and 1-year mortality rates of <= 13% and <= 15%, respectively. In contrast, patients who received a redo-LT for PNF showed worse outcomes with some values dramatically outside the redoLT benchmarks. Conclusion: This study shows that redo-LT achieves good outcome when looking at benchmark scenarios. However, this figure changes in high-risk redo-LT, as for example in PNF. This analysis objectifies for the first-time results and efforts for redo-LT and can serve as a basis for discussion about the use of scarce resources.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2022. Vol. 276, no 5, p. 860-867
Keywords [en]
benchmark, retransplantation, redo liver transplantation
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-487670DOI: 10.1097/SLA.0000000000005634ISI: 000864836700081PubMedID: 35894428OAI: oai:DiVA.org:uu-487670DiVA, id: diva2:1707823
Available from: 2022-11-01 Created: 2022-11-01 Last updated: 2022-11-01Bibliographically approved

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Ivanics, Tommy

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Figiel, WojciechShankar, SadhanaIvanics, Tommyde Meijer, Vincent E.Polak, Wojciech G.
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