Liver retransplants using living donors: An approach for management

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.(c) 2023 The Third Affiliated Hospital of Sun Yat-sen University. Publishing services by Elsevier B. V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).