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Advances in knowledge and techniques improved postoperative liver transplant outcomes, but optimizing re-liver transplant outcomes requires further research.
Initial liver transplant (LT) outcomes have improved over recent decades; however, liver re-transplant outcomes have not kept pace, Stanford University researchers report in Clinical Transplantation.
“Our study investigated the progress of liver re-transplant (re-LT) outcomes in the United States over the past two decades. The most important finding is that, while short-term results of re-LT have improved, the risk for re-LT itself compared to initial LT has not improved much,” study author Kazunari Sasaki, MD, says. “This underscores the need for strategies to enhance outcomes following re-LT.”
United Network for Organ Sharing Data Analyzed
To evaluate trends in re-LT characteristics and postoperative outcomes over time, Dr. Sasaki and his colleagues analyzed 2002–2021 data from the United Network for Organ Sharing database.
During this period, 128,462 adult patients received liver transplants. Of these, 7,254 (5.6%) were re-transplants. The study team found the median re-LT recipient age was significantly lower compared with the median initial LT age (52 vs. 55 years, P<0.01), while the median Model for End-Stage Liver Disease (MELD) score in the re-LT group was significantly higher (28 vs. 21, P<0.01). The waiting period for re-LT was much shorter when compared with the wait for primary LT (19 vs. 85 days, P<0.01).
Donors to recipients in the re-LT group were younger than those to recipients of initial liver transplants (35 vs. 41 years, P<0.01). In the re-LT group, the rate of liver transplant using donors after circulatory death was significantly lower than the rate among those in the initial transplant group (1.7% vs. 6.1%, P<0.01). Patients receiving liver re-transplants also tended to face longer travel distance to a donor hospital (85 vs. 66 miles, P<0.01) and longer cold ischemic time (6.3 vs. 6.0 hours, P<0.01) compared with patients receiving initial transplants.
From 2018 to 2021, graft survival for re-LT improved to 91.3% at 30 days, 82.1% at 1 year, and 70.8% at 3 years post-LT (Figure). Even so, hazard ratios for graft survival in re-LT remained elevated compared with marginal donors, including donors after circulatory death.
Changes in re-LT causes included less hepatitis C recurrence and more graft failure after primary LT involving donors after circulatory death.
Liver Re-Transplant Needs Further Research
“Postoperative LT outcomes have improved significantly over the past two decades due to advancements in medical techniques and accumulated knowledge. There has been plenty of research regarding initial LT,” Dr. Sasaki says. “However, re-LT has not been as thoroughly studied, and we do not have much information. Re-LT is a leftover field that needs investigation and improvement.”
Examining re-LT in detail “is difficult because there are not many cases,” he adds. “That is why we used a large national database to fill these knowledge gaps. However, given the organ shortage and the associated risks, it is essential to understand if and how re-LT has benefited from recent medical advances, especially compared with initial LT.”
He notes that re-LT can occur for several reasons, including acute or non-acute graft failures, and it is not certain how different causes of graft failure might influence re-LT success rates. “Our findings should further encourage doctors and researchers to work toward better understanding of re-LT,” Dr. Sasaki says. “We need more research to develop risk assessment tools specifically for re-LT. Such assessment tools will ultimately enhance patient outcomes and resource efficiency in re-LT.”
