Novel Benchmark Values for Redo Liver Transplantation
Fariba Abbassi, Dániel Gerö, Xavier Muller, Alba Bueno, Wojciech Figiel, Fabien Robin, Sophie Laroche, Benjamin Picard, Sadhana Shankar, Tommy Ivanics, Marjolein van Reeven, Otto B. van Leeuwen, Hillary J. Braun, Diethard Monbaliu, Antoine Breton, Neeta Vachharajani, Eliano Bonaccorsi Riani, Greg Nowak, Robert McMillan, Samir Abu‐Gazala, Amit Nair, Rocio Bruballa, Flavio Paterno, Deborah Weppler Sears, Antonio D. Pinna, James V. Guarrera, Eduardo de Santibáñes, Martín de Santibañes, Roberto Hernandez‐Alejandro, Kim M. Olthoff, R. Mark Ghobrial, Bo‐Göran Ericzon, Olga Ciccarelli, William C. Chapman, Jean‐Yves Mabrut, Jacques Pirenne, Beat Müllhaupt, Nancy L. Ascher, Robert J. Porte, Vincent E. de Meijer, Wojciech G. Polak, Gonzalo Sapisochín, Magdy Attia, Olivier Soubrane, Emmanuel Weiss, René Adam, Daniel Cherqui, Karim Boudjéma, Krzysztof Zieniewicz, Wayel Jassem, Philipp Dutkowski, Pierre‐Alain Clavien
Abstract
OBJECTIVE: To define benchmark cutoffs for redo liver transplantation (redo-LT). BACKGROUND: In the era of organ shortage, redo-LT is frequently discussed in terms of expected poor outcome and wasteful resources. However, there is a lack of benchmark data to reliably evaluate outcomes after redo-LT. METHODS: We collected data on redo-LT between January 2010 and December 2018 from 22 high-volume transplant centers. Benchmark cases were defined as recipients with model of end stage liver disease (MELD) score ≤25, absence of portal vein thrombosis, no mechanical ventilation at the time of surgery, receiving a graft from a donor after brain death. Also, high-urgent priority and early redo-LT including those for primary nonfunction (PNF) or hepatic artery thrombosis were excluded. Benchmark cutoffs were derived from the 75th percentile of the medians of all benchmark centers. RESULTS: Of 1110 redo-LT, 373 (34%) cases qualified as benchmark cases. Among these cases, the rate of postoperative complications until discharge was 76%, and increased up to 87% at 1-year, respectively. One-year overall survival rate was excellent with 90%. Benchmark cutoffs included Comprehensive Complication Index CCI ® at 1-year of ≤72, and in-hospital and 1-year mortality rates of ≤13% and ≤15%, respectively. In contrast, patients who received a redo-LT for PNF showed worse outcomes with some values dramatically outside the redo-LT benchmarks. CONCLUSION: This study shows that redo-LT achieves good outcome when looking at benchmark scenarios. However, this figure changes in high-risk redo-LT, as for example in PNF. This analysis objectifies for the first-time results and efforts for redo-LT and can serve as a basis for discussion about the use of scarce resources.