The aim of this research was to establish normative thresholds for repeat liver transplantation (redo-LT). Redo-LT is often discussed in terms of projected bad outcomes and wasted resources in this period of organ shortage. Unfortunately, there is little normative evidence upon which to base an accurate assessment of redo-effectiveness. LT’s Redo-liver transplant information was gathered from 22 high-volume transplant hospitals between January 2010 and December 2018. Patients who received a liver graft after the donor’s brain death and had a model of end-stage liver disease (MELD) score of less than or equal to 25 and no evidence of portal vein thrombosis, and who did not require artificial breathing during surgery were considered benchmark cases. Patients with a primary nonfunction (PNF) or hepatic artery thrombosis and those who need an early redo-LT due to a high level of urgency were not considered. Standard deviations were calculated by taking the 75th percentile of the medians across all benchmarks. Only 373 (or 34%) of the 1,110 redo-LT examples met the criteria for a benchmark. The rate of postoperative complications in these patients was 76% till discharge and 87% after 1 year. The overall survival rate was very high within a year at 90%. Standardized mortality rates of less than or equal to 13% in the hospital and less than or equal to 15% at 1 year were used as benchmarks, as was a Comprehensive Complication Index CCI® at 1 year of 72. On the other hand, patients who had a redo-LT for PNF had worse outcomes, with certain values being significantly off from redo-LT norms. Using benchmark cases, this research demonstrates that redo-LT produces satisfactory results. But with high-risk redo-LT, like PNF, this number shifts. This research provides a new, objective perspective on redo-LT outcomes and labor, which can inform decisions about allocating limited resources.
Source: journals.lww.com/annalsofsurgery/Abstract/2022/11000/Novel_Benchmark_Values_for_Redo_Liver.17.aspx
