Korean J Transplant.  2022 Nov;36(Supple 1):S8. 10.4285/ATW2022.F-0791.

Graft-recipient-weight ratio and lowered immunosuppression is important for the success of adult liver retransplantation: 25-year single center experience

• Rhu J
• Kim JM
• Choi Gs
• Joh JW

• KMID: 2535124
• DOI: http://doi.org/10.4285/ATW2022.F-0791

Abstract

Background
This study analyzed the risk of liver retransplantation and factors related to better outcome.
Methods
Adult liver transplantations performed during 1996 to 2021 were included. Comparison between first transplantation and retransplantation were performed. Among retransplantation cases, comparison between whole liver and partial liver graft was performed. Multivariable Cox analyses for analyzing risk factors for graft and overall survival were performed for the entire cohort as well as the subgroup of patients with retransplantation.
Results
A total 2,237 transplantations from 2,135 adults were included and 103 cases were retransplantation. A total of 44 (42.7%) cases were related to acute graft dysfunction while 59 (57.3%) cases were related to subacute or chronic graft dysfunction. Retransplantation was related poor graft (hazard ratio [HR], 3.439; confidence interval [CI], 2.230–5.304; P<0.001) and overall survival (HR, 2.905; CI, 2.089–4.040; P<0.001). Among retransplantations, mean serum FK506 trough level9ng/mL was related to poor graft (HR, 3.692; CI, 1.288–10.587; P=0.015) and overall survival (HR, 2.935; CI, 1.195–7.211; P=0.019). Graft-recipient-weight ratio under 1.0% was related to poor overall survival in retransplantations (HR, 3.668; CI, 1.150–11.698; P=0.028).
Conclusions
Retransplantation can be complicated with poor graft and patient survival compared to first transplantation, espe-cially when the graft size is relatively small. Lowering the FK506 trough level during the first month can be beneficial for outcome.