Skip to main content

Advertisement

SpringerLink
Log in

Mortality and Morbidity Among Adult Liver Retransplant Recipients

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. National Liver Transplants (Deceased Donors) through January 06, 2023. Organ Procurement & Transplantation Network (OPTN). https://insights.unos.org/OPTN-metrics/. Published 2023. Accessed 1/10/2023, 2023.

  2. Azoulay D, Linhares MM, Huguet E, et al. Decision for retransplantation of the liver: an experience- and cost-based analysis. Ann Surg. 2002;236:713–721; discussion 721.

  3. Yang LS, Shan LL, Saxena A, Morris DL. Liver transplantation: a systematic review of long-term quality of life. Liver Int. 2014;34:1298–1313.

    Article  PubMed  Google Scholar 

  4. Jain A, Reyes J, Kashyap R et al. Long-term survival after liver transplantation in 4,000 consecutive patients at a single center. Ann Surg. 2000;232:490–500.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Pfitzmann R, Benscheidt B, Langrehr JM, Schumacher G, Neuhaus R, Neuhaus P. Trends and experiences in liver retransplantation over 15 years. Liver Transpl. 2007;13:248–257.

    Article  PubMed  Google Scholar 

  6. Chen GH, Fu BS, Cai CJ et al. A single-center experience of retransplantation for liver transplant recipients with a failing graft. Transplant Proc. 2008;40:1485–1487.

    Article  PubMed  Google Scholar 

  7. Kashyap R, Jain A, Reyes J et al. Causes of retransplantation after primary liver transplantation in 4000 consecutive patients: 2 to 19 years follow-up. Transplant Proc. 2001;33:1486–1487.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Marudanayagam R, Shanmugam V, Sandhu B et al. Liver retransplantation in adults: a single-centre, 25-year experience. HPB (Oxford). 2010;12:217–224.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Shamsaeefar A, Saleh T, Kazemi K et al. Retransplant of the Liver: 12-Year Experience of the Shiraz Organs Transplantation Center. Exp Clin Transplant. 2021;19:44–49.

    Article  PubMed  Google Scholar 

  10. Zahr Eldeen F, Mabrouk Mourad M, Liossis C, Bramhall SR. Liver retransplant for primary disease recurrence. Exp Clin Transplant. 2014;12:175–183.

    PubMed  Google Scholar 

  11. López IP, Raya AM, Bastante MD et al. Liver Retransplantation: The Changing Scenario in a Tertiary Medical Center. Transplant Proc. 2020;52:543–545.

    Article  PubMed  Google Scholar 

  12. Yoon PD, Patel MS, Murillo Perez CF et al. Outcomes of Adult Liver Retransplantation: A Canadian National Database Analysis. Can J Gastroenterol Hepatol. 2022;2022:9932631.

    PubMed  PubMed Central  Google Scholar 

  13. Wang ZF, Liu C. Liver retransplantation: indications and outcomes. Hepatobiliary Pancreat Dis Int. 2004;3:175–178.

    PubMed  Google Scholar 

  14. Magee JC, Barr ML, Basadonna GP et al. Repeat organ transplantation in the United States, 1996–2005. Am J Transplant. 2007;7:1424–1433.

    Article  CAS  PubMed  Google Scholar 

  15. Adani GL, Baccarani U, Risaliti A et al. A single-center experience of late retransplantation of the liver. Transplant Proc. 2005;37:2599–2600.

    Article  CAS  PubMed  Google Scholar 

  16. Verna EC. The dynamic landscape of liver transplant in the era of effective hepatitis C virus therapy. Hepatology. 2017;65:763–766.

    Article  PubMed  Google Scholar 

  17. Nakamura T, Nobori S, Harada S et al. Impact of Donor and Recipient Age on Outcomes After Living Donor Liver Transplant. Transplant Proc. 2022;54:438–442.

    Article  PubMed  Google Scholar 

  18. Nitski O, Azhie A, Qazi-Arisar FA et al. Long-term mortality risk stratification of liver transplant recipients: real-time application of deep learning algorithms on longitudinal data. Lancet Digit Health. 2021;3:e295–e305.

    Article  CAS  PubMed  Google Scholar 

  19. Lang H, Sotiropoulos GC, Beckebaum S et al. Incidence of Liver Retransplantation and Its Effect on Patient Survival. Transplantation Proceedings. 2008;40:3201–3203.

    Article  CAS  PubMed  Google Scholar 

  20. Postma R, Haagsma EB, Peeters PM, van den Berg AP, Slooff MJ. Retransplantation of the liver in adults: outcome and predictive factors for survival. Transpl Int. 2004;17:234–240.

    Article  PubMed  Google Scholar 

  21. Markmann JF, Markowitz JS, Yersiz H, et al. Long-term survival after retransplantation of the liver. Ann Surg. 1997;226:408–418; discussion 418–420.

  22. Amiri M, Toosi MN, Moazzami B et al. Factors Associated With Length of Hospital Stay Following Liver Transplant Surgery. Exp Clin Transplant. 2020;18:313–319.

    Article  PubMed  Google Scholar 

  23. Rana A, Witte ED, Halazun KJ, et al. Liver transplant length of stay (LOS) index: A novel predictive score for hospital length of stay following liver transplantation. Clin Transplant. 2017;31(12).

  24. Tovikkai C, Charman SC, Praseedom RK, Gimson AE, van der Meulen J. Time spent in hospital after liver transplantation: Effects of primary liver disease and comorbidity. World J Transplant. 2016;6:743–750.

    Article  PubMed  PubMed Central  Google Scholar 

  25. VanWagner LB, Lapin B, Levitsky J et al. High early cardiovascular mortality after liver transplantation. Liver Transpl. 2014;20:1306–1316.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ripoll C, Yotti R, Bermejo J, Bañares R. The heart in liver transplantation. J Hepatol. 2011;54:810–822.

    Article  PubMed  Google Scholar 

  27. Nicolau-Raducu R, Gitman M, Ganier D et al. Adverse cardiac events after orthotopic liver transplantation: a cross-sectional study in 389 consecutive patients. Liver Transpl. 2015;21:13–21.

    Article  PubMed  Google Scholar 

  28. Dec GW, Kondo N, Farrell ML, Dienstag J, Cosimi AB, Semigran MJ. Cardiovascular complications following liver transplantation. Clin Transplant. 1995;9:463–471.

    CAS  PubMed  Google Scholar 

  29. Izzy M, VanWagner LB, Lee SS, Altieri M, Angirekula M, Watt KD. Understanding and managing cardiovascular outcomes in liver transplant recipients. Curr Opin Organ Transplant. 2019;24:148–155.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Barman PM, VanWagner LB. Cardiac Risk Assessment in Liver Transplant Candidates: Current Controversies and Future Directions. Hepatology. 2021;73:2564–2576.

    Article  PubMed  Google Scholar 

  31. Romero FA, Razonable RR. Infections in liver transplant recipients. World J Hepatol. 2011;3:83–92.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Blair JE, Kusne S. Bacterial, mycobacterial, and protozoal infections after liver transplantation–part I. Liver Transpl. 2005;11:1452–1459.

    Article  PubMed  Google Scholar 

  33. Jothimani D, Venugopal R, Vij M, Rela M. Post liver transplant recurrent and de novo viral infections. Best Pract Res Clin Gastroenterol. 2020;46–47:101689.

    Article  PubMed  Google Scholar 

  34. Kawecki D, Chmura A, Pacholczyk M, et al. Bacterial infections in the early period after liver transplantation: etiological agents and their susceptibility. Med Sci Monit. 2009;15:Cr628–637.

  35. Cheng H, Chen BP, Soleas IM, Ferko NC, Cameron CG, Hinoul P. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surg Infect (Larchmt). 2017;18:722–735.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Verberk JDM, Meijs AP, Vos MC et al. Contribution of Prior, Multiple-, and Repetitive Surgeries to the Risk of Surgical Site Infections in the Netherlands. Infect Control Hosp Epidemiol. 2017;38:1298–1305.

    Article  PubMed  Google Scholar 

  37. Biggins SW, Gralla J, Dodge JL et al. Survival benefit of repeat liver transplantation in the United States: a serial MELD analysis by hepatitis C status and donor risk index. Am J Transplant. 2014;14:2588–2594.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Masior Ł, Grąt M. Primary Nonfunction and Early Allograft Dysfunction after Liver Transplantation. Dig Dis. 2022;40:766–776.

    Article  PubMed  Google Scholar 

  39. Wagener G, Raffel B, Young AT, Minhaz M, Emond J. Predicting early allograft failure and mortality after liver transplantation: the role of the postoperative model for end-stage liver disease score. Liver Transpl. 2013;19:534–542.

    Article  PubMed  Google Scholar 

  40. Al-Adra DP, Hammel L, Roberts J et al. Preexisting melanoma and hematological malignancies, prognosis, and timing to solid organ transplantation: A consensus expert opinion statement. Am J Transplant. 2021;21:475–483.

    Article  PubMed  Google Scholar 

  41. Verna EC, Patel YA, Aggarwal A et al. Liver transplantation for hepatocellular carcinoma: Management after the transplant. American Journal of Transplantation. 2020;20:333–347.

    Article  PubMed  Google Scholar 

  42. Colmenero J, Tabrizian P, Bhangui P et al. De Novo Malignancy After Liver Transplantation: Risk Assessment, Prevention, and Management-Guidelines From the ILTS-SETH Consensus Conference. Transplantation. 2022;106:e30–e45.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The data reported in this study have been supplied by the Hennepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government

Funding

Dr. Lee is supported by U01 DK58369 and by research support from Intercept, Aurora, Gilead, Novo Nordisk, Alexion, Eiger, Camurus and Lipocine, and consults for Forma, SeaGen, GSK, Karuna, and Cortexyme. Dr. Cotter is supported by NIH grant U01 AA026975 and by the AASLD Clinical, Translational and Outcomes Research Awards in Liver Disease. Funding was provided by Southwestern Medical Foundation (Jeanne Roberts Fund).

Author information

Author notes

  1. Ali Dakroub and Ahmad Anouti have equally contributed to this work.

Authors and Affiliations

  1. St. Francis Hospital and Heart Center, Roslyn, NY, USA

    Ali Dakroub

  2. Division of Digestive and Liver Diseases, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA

    Ahmad Anouti, Thomas G. Cotter & William M. Lee

Authors
  1. Ali Dakroub
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmad Anouti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas G. Cotter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. William M. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AD and AA—study concept and design; acquisition, analysis and interpretation of data; drafting and critical revision of manuscript for important intellectual content. WL– study design and critical revision of manuscript for important intellectual content. TG—critical revision of manuscript for important intellectual content. All authors approved final version to be published.

Corresponding author

Correspondence to William M. Lee.

Ethics declarations

Conflict of interest

AD and AA have no disclosures.

Ethical approval

This study is based on a retrospective analysis of a deidentified database, as such the need for patient consent and Institutional Review Board (IRB) approval was waived.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dakroub, A., Anouti, A., Cotter, T.G. et al. Mortality and Morbidity Among Adult Liver Retransplant Recipients. Dig Dis Sci 68, 4039–4049 (2023). https://doi.org/10.1007/s10620-023-08065-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-023-08065-2

Keywords

Search

Navigation