Liver retransplants using living donors: An approach for management

Abstract

Background and aims

Many centers do not offer living donor transplants for patients in need of a liver retransplant. We aimed to study our liver retransplant outcomes using living donors and compared them with those of retransplants performed using deceased donors.

Methods

This study retrospectively analyzed all retransplants performed at our center between 2009 and 2023, and outcomes of living donor retransplants were compared with deceased donor retransplants using standard statistical tests.

Results

Between January 2009 and March 2023, a total of 77 retransplants, 60 with deceased donors and 17 with living donors, were performed. Important demographic differences between the two groups included a higher model for end-stage liver disease score in the deceased donor group (32.1 ± 6.1 vs. 19.4 ± 5.7, P < 0.001) and a higher number of early retransplants (within 3 months of the initial transplant), which accounted for 35% of deceased donor transplants but 0 of living donor transplants (P < 0.01). Overall, the patient and graft survival rates were comparable between the two groups. The patient survival rates at 1 and 3 years after transplant were 73% and 67% in the deceased donor group and 84% and 73% in the living donor group, respectively (P = 0.57). The hospital length of stay and blood product use were both better in the living donor group. Biliary complications did not show significant different between the two groups (P = 0.33).

Conclusions

Living donors can provide acceptable outcomes for those in need of a retransplant, with results comparable to those seen with deceased donors. A systematic approach to the patient in the pre-, peri-, and post-transplantation period is important in these complicated cases.