Analysis of Liver Retransplantation in a Reference Center in Southern Spain: 27 Years of Experience

Liver retransplantation (LRT) is the only therapeutic option in cases of irreversible graft failure. It is a technically complex procedure associated with high morbidity and mortality and worse survival outcomes compared to primary liver transplantation.

To analyze the indications, outcomes, and survival rates of LRT in a referral hospital in southern Spain over a 27-year period.

A retrospective descriptive study of all LRTs performed between 1997 and 2024 at the Regional University Hospital of Málaga. Solid organ transplants other than liver were excluded. Qualitative variables were expressed as percentages and quantitative variables as medians and interquartile ranges. A P-value < .05 was considered statistically significant.

A total of 1.362 liver transplants (LTs) were performed during the study period, of which 76 were LRTs (5.6%). The median age of recipients was 53 years; 63.2% were male. The main indications for LRT were hepatic artery thrombosis (HAT) (28.9%), primary nonfunction (PNF) (23.7%), and chronic rejection (18.4%). Overall mortality was 55.3%, with the main cause being perioperative complications (28.6%). One-year and five-year survival rates were 59.2% and 46.1%, respectively. Urgent LRT (≤7 days) was associated with worse five-year survival compared to nonurgent LRT (33.3% vs 62.8%; P = .02).

LRT, though infrequent, carries high morbidity and mortality. Long-term survival was significantly better in nonurgent cases, emphasizing the importance of proper timing and clinical stabilization before surgery.