TY - JOUR
T1 - Novel Benchmark Values for Redo Liver Transplantation
T2 - Does the Outcome Justify the Effort?
AU - Abbassi, Fariba
AU - Gero, Daniel
AU - Muller, Xavier
AU - Bueno, Alba
AU - Figiel, Wojciech
AU - Robin, Fabien
AU - Laroche, Sophie
AU - Picard, Benjamin
AU - Shankar, Sadhana
AU - Ivanics, Tommy
AU - van Reeven, Marjolein
AU - van Leeuwen, Otto B.
AU - Braun, Hillary J.
AU - Monbaliu, Diethard
AU - Breton, Antoine
AU - Vachharajani, Neeta
AU - Bonaccorsi Riani, Eliano
AU - Nowak, Greg
AU - McMillan, Robert R.
AU - Abu-Gazala, Samir
AU - Nair, Amit
AU - Bruballa, Rocio
AU - Paterno, Flavio
AU - Weppler Sears, Deborah
AU - Pinna, Antonio D.
AU - Guarrera, James V.
AU - de Santibañes, Eduardo
AU - de Santibañes, Martin
AU - Hernandez-Alejandro, Roberto
AU - Olthoff, Kim
AU - Ghobrial, R. Mark
AU - Ericzon, Bo Göran
AU - Ciccarelli, Olga
AU - Chapman, William C.
AU - Mabrut, Jean Yves
AU - Pirenne, Jacques
AU - Müllhaupt, Beat
AU - Ascher, Nancy L.
AU - Porte, Robert J.
AU - de Meijer, Vincent E.
AU - Polak, Wojciech G.
AU - Sapisochin, Gonzalo
AU - Attia, Magdy
AU - Soubrane, Olivier
AU - Weiss, Emmanuel
AU - Adam, René A.
AU - Cherqui, Daniel
AU - Boudjema, Karim
AU - Zieniewicz, Krzysztof
AU - Jassem, Wayel
AU - Dutkowski, Philipp
AU - Clavien, Pierre Alain
N1 - Funding Information:
This study is supported by the LGID (Liver and Gastrointestinal Disease) Foundation.
Publisher Copyright:
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2022/11/1
Y1 - 2022/11/1
N2 - 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.
AB - 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.
KW - benchmark
KW - redo liver transplantation
KW - retransplantation
KW - Liver Transplantation
KW - Humans
KW - End Stage Liver Disease/surgery
KW - Tissue and Organ Procurement
KW - Benchmarking
KW - Graft Survival
KW - Treatment Outcome
KW - Retrospective Studies
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U2 - 10.1097/SLA.0000000000005634
DO - 10.1097/SLA.0000000000005634
M3 - Article
C2 - 35894428
AN - SCOPUS:85139571718
SN - 0003-4932
VL - 276
SP - 860
EP - 867
JO - Annals of surgery
JF - Annals of surgery
IS - 5
ER -