Novel Benchmark Values for Redo Liver Transplantation: Does the Outcome Justify the Effort?

Area of Science:

• Hepatology
• Transplantation Surgery
• Medical Outcomes Research

Background:

• Redo liver transplantation (redo-LT) is increasingly common due to organ shortages.
• Evaluating redo-LT outcomes is challenging due to a lack of benchmark data.
• Concerns exist regarding resource allocation and expected poor outcomes in redo-LT.

Purpose of the Study:

• To establish benchmark criteria for evaluating redo liver transplantation (redo-LT) outcomes.
• To provide objective data for assessing the efficacy of redo-LT.
• To inform discussions on resource utilization in liver transplantation.

Main Methods:

• Data from 1110 redo-LT procedures between 2010-2018 were analyzed from 22 high-volume centers.
• Benchmark cases were defined by specific criteria (MELD ≤25, no PVT, no ventilation, DBD donor), excluding high-urgent and early retransplants.
• Benchmark cutoffs were determined using the 75th percentile of median values from benchmark centers.

Main Results:

• 373 (34%) redo-LT cases met benchmark criteria.
• Benchmark cases had 76% postoperative complications by discharge, rising to 87% at 1 year.
• One-year survival in benchmark cases was 90%, with defined cutoffs for Comprehensive Complication Index (CCI) and mortality.
• Redo-LT for primary nonfunction (PNF) demonstrated poorer outcomes compared to benchmarks.

Conclusions:

• Redo liver transplantation (redo-LT) demonstrates good outcomes in defined benchmark scenarios.
• High-risk redo-LT, particularly for primary nonfunction (PNF), is associated with worse outcomes.
• This study provides objective benchmarks for redo-LT, aiding resource allocation discussions.