Abbassi F, Gero D, Muller X, Bueno A, Figiel W, Robin F, Laroche S, Picard B, Shankar S, Ivanics T, van Reeven M, van Leeuwen OB, Braun HJ, Monbaliu D, Breton A, Vachharajani N, Bonaccorsi Riani E, Nowak G, McMillan RR, Abu-Gazala S, Nair A, Bruballa R, Paterno F, Weppler Sears D, Pinna AD, Guarrera JV, de Santibañes E, de Santibañes M, Hernandez-Alejandro R, Olthoff K, Ghobrial RM, Ericzon BG, Ciccarelli O, Chapman WC, Mabrut JY, Pirenne J, Müllhaupt B, Ascher NL, Porte RJ, de Meijer VE, Polak WG, Sapisochin G, Attia M, Weiss E, Adam RA, Cherqui D, Boudjema K, Zienewicz K, Jassem W, Dutkowski P, and Clavien PA. Novel Benchmark Values for Redo Liver Transplantation. Does the Outcome Justify the Effort? Ann Surg 2022.
Annals of surgery
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 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 non-function (PNF) or hepatic artery thrombosis were excluded. Benchmark cutoffs were derived from the 75th percentile of the medians of all benchmark centers.
RESULTS: Out 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 major 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.
ePub ahead of print