title: Outcomes of liver retransplantation in patients with primary sclerosing cholangitis.
abstract: Liver retransplantation in patients with primary sclerosing cholangitis (PSC) has not been well studied. The aims of this study were to characterize patients with PSC listed for and undergoing retransplantation and to describe the outcomes in these patients. The United Network for Organ Sharing/Organ Procurement and Transplantation Network database was used to identify all primary liver transplantations and subsequent relistings and first retransplantations in adults with PSC between 1987 and 2015. A total of 5080 adults underwent primary transplantation for PSC during this period, and of the 1803 who experienced graft failure (GF), 762 were relisted, and 636 underwent retransplantation. Younger patients and patients with GF due to vascular thrombosis or biliary complications were more likely to be relisted, whereas those with Medicaid insurance or GF due to infection were less likely. Both 5-year graft and patient survival after retransplantation were inferior to primary transplantation (P < 0.001). Five-year survival after retransplantation for disease recurrence (REC), however, was similar to primary transplantation (graft survival, P = 0.45; patient survival, P = 0.09) and superior to other indications for retransplantation (graft and patient survival, P < 0.001). On multivariate analysis, mechanical ventilation, creatinine, bilirubin, albumin, advanced donor age, and a living donor were associated with poorer outcomes after retransplantation. In conclusion, although survival after liver retransplantation in patients with PSC was overall inferior to primary transplantation, outcomes after retransplantation for PSC REC were similar to primary transplantation at 5 years. Retransplantation may therefore represent a treatment option with the potential for excellent outcomes in patients with REC of PSC in the appropriate clinical circumstances. Liver Transplantation 23 769-780 2017 AASLD.
authors.affiliation: Duke University School of Medicine, Durham, NC.
authors.forename: Jacqueline B
authors.initials: JB
authors.lastname: Henson
authors.affiliation: Division of Gastroenterology, Departments of Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Yuval A
authors.initials: YA
authors.lastname: Patel
authors.affiliation: Division of Gastroenterology, Departments of Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Lindsay Y
authors.initials: LY
authors.lastname: King
authors.affiliation: Biostatistics, Duke University School of Medicine, Durham, NC.
authors.forename: Jiayin
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Biostatistics, Duke University School of Medicine, Durham, NC.|Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
authors.forename: Shein-Chung
authors.initials: SC
authors.lastname: Chow
authors.affiliation: Division of Gastroenterology, Departments of Medicine, Duke University School of Medicine, Durham, NC.|Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Muir
mesh_terms: D000328:Adult; D015209:Cholangitis, Sclerosing / Q000401:mortality / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D008099:Liver / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012086:Reoperation / Q000009:adverse effects / Q000379:methods*; D012121:Respiration, Artificial; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists