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Long-term outcomes of retransplantation after live donor liver transplantation : A Western experience

Ivanics, Tommy (author)
Uppsala universitet,Gastrointestinalkirurgi,Univ Hlth Network, Multi Organ Transplant Program, Toronto, ON, Canada.;Henry Ford Hosp, Dept Surg, Detroit, MI USA.
Limkemann, Ashley (author)
Ohio State Univ, Dept Surg, Div Transplantat, Wexner Med Ctr, Columbus, OH USA.
Patel, Madhukar S. (author)
Univ Texas Southwestern Med Ctr, Dept Surg, Div Surg Transplantat, Dallas, TX USA.
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Claasen, Marco P. A. W. (author)
Univ Hlth Network, Multi Organ Transplant Program, Toronto, ON, Canada.;Univ Med Ctr Rotterdam, Erasmus MC Transplant Inst, Dept Surg, Div Hepatopancreatobiliary & Transplant Surg, Rotterdam, Netherlands.
Rajendran, Luckshi (author)
Univ Toronto, Toronto Gen Hosp, Div Gen Surg, Toronto, ON, Canada.
Choi, Woo Jin (author)
Univ Toronto, Toronto Gen Hosp, Div Gen Surg, Toronto, ON, Canada.
Shwaartz, Chaya (author)
Univ Hlth Network, Multi Organ Transplant Program, Toronto, ON, Canada.
Selzner, Nazia (author)
Univ Hlth Network, Multi Organ Transplant Program, Toronto, ON, Canada.;Univ Toronto, Dept Med, Div Gastroenterol, Toronto, ON, Canada.;Toronto Gen Hosp, Res Inst, Toronto, ON, Canada.
Lilly, Les (author)
Univ Hlth Network, Multi Organ Transplant Program, Toronto, ON, Canada.;Univ Toronto, Dept Med, Div Gastroenterol, Toronto, ON, Canada.;Toronto Gen Hosp, Res Inst, Toronto, ON, Canada.
Bhat, Mamatha (author)
Univ Hlth Network, Multi Organ Transplant Program, Toronto, ON, Canada.;Univ Toronto, Dept Med, Div Gastroenterol, Toronto, ON, Canada.;Toronto Gen Hosp, Res Inst, Toronto, ON, Canada.
Tsien, Cynthia (author)
Univ Hlth Network, Multi Organ Transplant Program, Toronto, ON, Canada.;Univ Toronto, Dept Med, Div Gastroenterol, Toronto, ON, Canada.;Toronto Gen Hosp, Res Inst, Toronto, ON, Canada.
Selzner, Markus (author)
Univ Hlth Network, Multi Organ Transplant Program, Toronto, ON, Canada.
McGilvray, Ian (author)
Univ Hlth Network, Multi Organ Transplant Program, Toronto, ON, Canada.
Sayed, Blayne (author)
Univ Hlth Network, Multi Organ Transplant Program, Toronto, ON, Canada.
Reichman, Trevor (author)
Univ Hlth Network, Multi Organ Transplant Program, Toronto, ON, Canada.
Cattral, Mark (author)
Univ Hlth Network, Multi Organ Transplant Program, Toronto, ON, Canada.
Ghanekar, Anand (author)
Univ Hlth Network, Multi Organ Transplant Program, Toronto, ON, Canada.;Hosp Sick Children, Transplant & Regenerat Med Ctr, Toronto, ON, Canada.
Sapisochin, Gonzalo (author)
Univ Hlth Network, Multi Organ Transplant Program, Toronto, ON, Canada.;Univ Toronto, Toronto Gen Hosp, Div Gen Surg, Toronto, ON, Canada.
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 (creator_code:org_t)
Elsevier, 2023
2023
English.
In: Surgery. - : Elsevier. - 0039-6060 .- 1532-7361. ; 173:2, s. 529-536
Related links:
https://urn.kb.se/re...
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https://doi.org/10.1...
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  • Journal article (peer-reviewed)
Abstract Subject headings
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  • Background: Despite most liver transplants in North America being from deceased donors, the number of living donor liver transplants has increased over the last decade. Although outcomes of liver retransplantation after deceased donor liver transplantation have been widely published, outcomes of retransplant after living donor liver transplant need to be further elucidated. Method: We aimed to compare waitlist outcomes and survival post-retransplant in recipients of initial living or deceased donor grafts. Adult liver recipients relisted at University Health Network between April 2000 and October 2020 were retrospectively identified and grouped according to their initial graft: living donor liver transplants or deceased donor liver transplant. A competing risk multivariable model evaluated the association between graft type at first transplant and outcomes after relisting. Survival after retransplant waitlisting (intention-to-treat) and after retransplant (per protocol) were also assessed. Multivariable Cox regression evaluated the effect of initial graft type on survival after retransplant. Results: A total of 201 recipients were relisted (living donor liver transplants, n = 67; donor liver transplants, n = 134) and 114 underwent retransplant (living donor liver transplants, n = 48; deceased donor liver transplants, n = 66). The waitlist mortality with an initial living donor liver transplant was not significantly different (hazard ratio = 0.51; 95% confidence interval, 0.23-1.10; P = .08). Both unadjusted and adjusted graft loss risks were similar post-retransplant. The risk-adjusted overall intentionto-treat survival after relisting (hazard ratio = 0.76; 95% confidence interval, 0.44-1.32; P =.30) and per protocol survival after retransplant (hazard ratio:1.51; 95% confidence interval, 0.54-4.19; P =.40) were equivalent in those who initially received a living donor liver transplant. Conclusion: Patients requiring relisting and retransplant after either living donor liver transplants or deceased donor liver transplantation experience similar waitlist and survival outcomes.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

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