Related Experiment Video
Updated: Jun 2, 2026
Reduced Complications after Arterial Reconnection in a Rat Model of Orthotopic Liver Transplantation
Published on: November 7, 2020
Long-term outcomes after third liver transplant
C Burcin Taner1, Deniz Balci, Darrin L Willingham
1Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL 32224, USA. taner.burcin@mayo.edu
Insights
Multiple orthotopic liver transplants can lead to acceptable patient survival, even after third graft failure. Transplant centers should consider program volume and outcomes when deciding on these complex retransplants.
Area of Science:
- Hepatology
- Transplant Surgery
- Immunology
Background:
- Orthotopic liver transplant is standard for end-stage liver disease.
- Liver retransplant after first graft failure is common.
- Third orthotopic liver transplant is rare and performed at select centers.
Purpose of the Study:
- To analyze long-term outcomes of patients undergoing three or more orthotopic liver transplants.
- To evaluate survival rates and influencing factors in this unique patient cohort.
Main Methods:
- Retrospective analysis of 24 patients who received 3+ orthotopic liver transplants.
- Data collected from February 1998 to August 2009 at Mayo Clinic, Florida.
- Examined patient survival and graft donor risk index scores.
Main Results:
- Mean patient survival was 103.8 months.
- Actuarial survival at 1, 5, and 10 years post-transplant was 60%, 40%, and 33%, respectively.
- Lower donor risk index scores correlated with better survival; scores >1.6 significantly reduced survival rates.
Conclusions:
- Multiple liver retransplants demonstrate acceptable patient survival.
- Transplant programs must weigh individual program volume and outcomes.
- Consideration of access for first-time transplant candidates is crucial in decision-making.
Objectives:
Orthotopic liver transplant is the treatment of choice for patients with end-stage liver disease. Patients with first graft failure requiring liver retransplant are commonly seen at most liver transplant centers. However, patients with a second graft failure requiring a third graft are uncommon. Liver retransplant in this setting has only been pursued at a few large transplant centers.
Materials And Methods:
This is a retrospective analysis of the long-term outcomes of recipients who underwent 3 or more orthotopic liver transplants. Between February 1998 and August 2009, 24 patients had 3 or more orthotopic liver transplants at the Mayo Clinic in Florida.
Results:
Mean patient survival was 103.8 months for the study cohort. Actuarial patient survival after the last orthotopic liver transplant in -1, -5, and -10 years was 60%, 40%, 33%. Patients were transplanted with lower donor risk index score grafts in each subsequent orthotopic liver transplant. Patients who had a graft with a donor risk index score > 1.6 at the time of the third orthotopic liver transplant had significantly lower survival rate compared with those with grafts with a donor risk index score ≤ 1.6.
Conclusions:
Multiple liver retransplants offer acceptable patient survival. Each transplant program must decide whether to do multiple orthotopic liver transplants based on the program's transplant volume and outcomes to help this subgroup of patients. The concerns of potentially decreasing access to first time orthotopic liver transplant candidates should also be weighed in the decision to move forward.
Related Concept Videos
01:16Kidney Transplant III: Nursing Management
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...