• Fady M Kaldas, Julian K Horwitz, Daisuke Noguchi, Islam M Korayem, Daniela Markovic, Samer Ebaid, Vatche G Agopian, Hasan Yersiz, Sammy Saab, Steven B Han, Mohamad M El Kabany, Gina Choi, Akshay Shetty, Jasleen Singh, Christopher Wray, Igor Barjaktarvic, Douglas G Farmer, and Ronald W Busuttil.
• Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA.
• Ann. Surg. 2023 Sep 1; 278 (3): 441451441-451.

ObjectiveTo examine liver retransplantation (ReLT) over 35 years at a single center.BackgroundDespite the durability of liver transplantation (LT), graft failure affects up to 40% of LT recipients.MethodsAll adult ReLTs from 1984 to 2021 were analyzed. Comparisons were made between ReLTs in the pre versus post-model for end-stage liver disease (MELD) eras and between ReLTs and primary-LTs in the modern era. Multivariate analysis was used for prognostic modeling.ResultsSix hundred fifty-four ReLTs were performed in 590 recipients. There were 372 pre-MELD ReLTs and 282 post-MELD ReLTs. Of the ReLT recipients, 89% had one previous LT, whereas 11% had ≥2. Primary nonfunction was the most common indication in the pre-MELD era (33%) versus recurrent disease (24%) in the post-MELD era. Post-MELD ReLT recipients were older (53 vs 48, P = 0.001), had higher MELD scores (35 vs 31, P = 0.01), and had more comorbidities. However, post-MELD ReLT patients had superior 1, 5, and 10-year survival compared with pre-MELD ReLT (75%, 60%, and 43% vs 53%, 43%, and 35%, respectively, P < 0.001) and lower in-hospital mortality and rejection rates. Notably, in the post-MELD era, the MELD score did not affect survival. We identified the following risk factors for early mortality (≤12 months after ReLT): coronary artery disease, obesity, ventilatory support, older recipient age, and longer pre-ReLT hospital stay.ConclusionsThis represents the largest single-center ReLT report to date. Despite the increased acuity and complexity of ReLT patients, post-MELD era outcomes have improved. With careful patient selection, these results support the efficacy and survival benefit of ReLT in an acuity-based allocation environment.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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