AUTHOR=Brombosz Elizabeth W. , Moore Linda W. , Mobley Constance M. , Kodali Sudha , Saharia Ashish , Hobeika Mark J. , Connor Ashton A. , Victor David W. , Cheah Yee Lee , Simon Caroline J. , Gaber Ahmed Osama , Ghobrial Rafik Mark 

TITLE=Factors affecting survival after liver retransplantation: a systematic review and meta-analysis

JOURNAL=Frontiers in Transplantation

VOLUME=Volume 2 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/transplantation/articles/10.3389/frtra.2023.1181770

DOI=10.3389/frtra.2023.1181770

ISSN=2813-2440

ABSTRACT=Background: Liver retransplantation (reLT) has historically had inferior survival relative to primary liver transplant (LT). To improve outcomes after reLT, researchers have identified factors predicting overall (OS) and/or graft survival (GS) after reLT. This systematic review and random effects meta-analysis sought to summarize this literature to elucidate the strongest independent predictors of post-reLT.

Methods: A systematic review was conducted to identify manuscripts reporting factors affecting survival in multivariable Cox proportional hazards analyses. Papers with overlapping cohorts were excluded. 

Results: All 25 included studies were retrospective, and 15 (60%) were single-center studies. Patients on pre-transplant ventilation (HR, 3.11; 95% CI, 1.56-6.20; p=0.001) and with high serum creatinine (HR, 1.46; 95% CI, 1.15-1.87; p=0.002) had the highest mortality risk after reLT. Recipient age, Model for End-Stage Liver Disease score, donor age, and cold ischemia time >12 h also conferred a significant risk of post-reLT death (all p<0.05). Factors affecting GS included donor age and retransplant interval (the time between LT and reLT; both p<0.05). OS is significantly higher when the retransplant interval is ≤7 d relative to 8-30 days (p=0.04). 

Conclusions: The meta-analysis was complicated by papers utilizing non-standardized cut-off values to group variables, which made between-study comparisons difficult. However, it did identify 7 variables that significantly impact survival after reLT, which could stimulate future research into improving post-reLT outcomes.