• Fariba Abbassi, Daniel Gero, Xavier Muller, Alba Bueno, Wojciech Figiel, Fabien Robin, Sophie Laroche, Benjamin Picard, Sadhana Shankar, Tommy Ivanics, Marjolein van Reeven, Otto B van Leeuwen, Hillary J Braun, Diethard Monbaliu, Antoine Breton, Neeta Vachharajani, Eliano Bonaccorsi Riani, Greg Nowak, Robert R McMillan, Samir Abu-Gazala, Amit Nair, Rocio Bruballa, Flavio Paterno, Deborah Weppler Sears, Antonio D Pinna, James V Guarrera, Eduardo de Santibañes, Martin de Santibañes, Roberto Hernandez-Alejandro, Kim Olthoff, R Mark Ghobrial, Bo-Göran Ericzon, Olga Ciccarelli, William C Chapman, Jean-Yves Mabrut, Jacques Pirenne, Beat Müllhaupt, Nancy L Ascher, Robert J Porte, Vincent E de Meijer, Wojciech G Polak, Gonzalo Sapisochin, Magdy Attia, Olivier Soubrane, Emmanuel Weiss, René A Adam, Daniel Cherqui, Karim Boudjema, Krzysztof Zieniewicz, Wayel Jassem, Philipp Dutkowski, and Pierre-Alain Clavien.
• Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
• Ann. Surg. 2022 Nov 1; 276 (5): 860867860-867.

ObjectiveTo define benchmark cutoffs for redo liver transplantation (redo-LT).BackgroundIn 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.MethodsWe 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.ResultsOf 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 ® 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 redo-LT benchmarks.ConclusionThis 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.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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