title: High risk, high reward: An analysis of outcomes for candidates awaiting hepatic re-transplantation.
abstract: Background. Liver re-transplantation (re-OLT) remains the only feasible option for patients with graft failure following liver transplantation. Sparse resources and a growing waitlist mandate that available grafts are allocated properly. We studied the differences in patient demographics, characteristics, and survival for those listed for re-OLT in a region with prolonged wait times.
  
  
  METHODS
  We performed a single-center retrospective study, from 2005 to 2013, of adult candidates listed for liver re-OLT at a tertiary care center within United Network for Organ Sharing (UNOS) region 1.
  
  
  RESULTS
  Of the 48 patients listed for re-OLT, 1(2%) improved while waiting, 14(29%) died while waiting, and 33(69%) underwent re-OLT. Those re-transplanted represented 11% of the center's adult liver transplant volume during the same time period. Comparing those who died while waiting to those who achieved re-OLT, there was no significant difference in age (median 52 vs. 48 years, p=0.56) or MELD at second listing (median 29 vs. 26, p = 0.90). Waitlisted candidates who failed to achieve re-transplant died on average of 15.5 days (IQR 36 days) days after re-listing. Those re-transplanted achieved 3-year survival of 70% and there was no significant difference in 3-year survival of those re-transplanted within or beyond 90 days of first transplant (70% vs. 69.5%, p = 0.28).
  
  
  CONCLUSIONS
  In conclusion, re-OLT is the only viable option for candidates with nonreversible liver graft failure. Inability to achieve re-OLT leads to nearly assured and expeditious death. Despite technical challenges, in experienced hands excellent long term survival following re-OLT can be achieved.
authors.affiliation: Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
authors.forename: Jigesh A
authors.initials: JA
authors.lastname: Shah
authors.affiliation: Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
authors.forename: Madhukar S
authors.initials: MS
authors.lastname: Patel
authors.affiliation: University of California San Francisco, San Francisco, CA, USA.
authors.forename: Johannes R
authors.initials: JR
authors.lastname: Kratz
authors.affiliation: Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Markmann
authors.affiliation: Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
authors.forename: Parsia A
authors.initials: PA
authors.lastname: Vagefi
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D061665:Time-to-Treatment; D017211:Treatment Failure; D014850:Waiting Lists / Q000401:mortality