Frontiers in Transplantation (May 2023)

Factors affecting survival after liver retransplantation: a systematic review and meta-analysis

  • Elizabeth W. Brombosz,
  • Linda W. Moore,
  • Linda W. Moore,
  • Constance M. Mobley,
  • Constance M. Mobley,
  • Constance M. Mobley,
  • Constance M. Mobley,
  • Sudha Kodali,
  • Sudha Kodali,
  • Sudha Kodali,
  • Ashish Saharia,
  • Ashish Saharia,
  • Ashish Saharia,
  • Ashish Saharia,
  • Mark J. Hobeika,
  • Mark J. Hobeika,
  • Mark J. Hobeika,
  • Ashton A. Connor,
  • Ashton A. Connor,
  • Ashton A. Connor,
  • Ashton A. Connor,
  • David W. Victor,
  • David W. Victor,
  • David W. Victor,
  • Yee Lee Cheah,
  • Yee Lee Cheah,
  • Yee Lee Cheah,
  • Caroline J. Simon,
  • Caroline J. Simon,
  • Caroline J. Simon,
  • Ahmed Osama Gaber,
  • Ahmed Osama Gaber,
  • Ahmed Osama Gaber,
  • Rafik Mark Ghobrial,
  • Rafik Mark Ghobrial,
  • Rafik Mark Ghobrial,
  • Rafik Mark Ghobrial

DOI
https://doi.org/10.3389/frtra.2023.1181770
Journal volume & issue
Vol. 2

Abstract

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BackgroundLiver retransplantation (reLT) has historically had inferior survival relative to primary liver transplant (LT). To improve outcomes after reLT, researchers have identified factors predicting overall (OS) and/or graft survival (GS) after reLT. This systematic review and random effects meta-analysis sought to summarize this literature to elucidate the strongest independent predictors of post-reLT.MethodsA systematic review was conducted to identify manuscripts reporting factors affecting survival in multivariable Cox proportional hazards analyses. Papers with overlapping cohorts were excluded.ResultsAll 25 included studies were retrospective, and 15 (60%) were single-center studies. Patients on pre-transplant ventilation (HR, 3.11; 95% CI, 1.56–6.20; p = 0.001) and with high serum creatinine (HR, 1.46; 95% CI, 1.15–1.87; p = 0.002) had the highest mortality risk after reLT. Recipient age, Model for End-Stage Liver Disease score, donor age, and cold ischemia time >12 h also conferred a significant risk of post-reLT death (all p < 0.05). Factors affecting GS included donor age and retransplant interval (the time between LT and reLT; both p < 0.05). OS is significantly higher when the retransplant interval is ≤7 days relative to 8–30 days (p = 0.04).ConclusionsThe meta-analysis was complicated by papers utilizing non-standardized cut-off values to group variables, which made between-study comparisons difficult. However, it did identify 7 variables that significantly impact survival after reLT, which could stimulate future research into improving post-reLT outcomes.

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