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

Tommy Ivanics, Ashley Limkemann, Madhukar S. Patel, Marco P.A.W. Claasen, Luckshi Rajendran, Woo JIn Choi, Chaya Shwaartz, Nazia Selzner, Les Lilly, Mamatha Bhat, Cynthia Tsien, Markus Selzner, Ian McGilvray, Blayne Sayed, Trevor Reichman, Mark Cattral, Anand Ghanekar, Gonzalo Sapisochin*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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 intention-to-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.

Original languageEnglish
Pages (from-to)529-536
Number of pages8
JournalSurgery (United States)
Issue number2
Early online date2 Nov 2022
Publication statusPublished - Feb 2023

Bibliographical note

Funding Information:
No preregistration exists for the studies reported in this article.

Publisher Copyright:
© 2022 Elsevier Inc.


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