Impact of comorbidity on waiting list and post-transplant outcomes in patients undergoing liver retransplantation

Table 1 Baseline characteristics for patients who had primary liver transplantation and those who had liver retransplantation

Variables	PLT (n = 1090)	LRT (n = 150)	P value
Demographic
Age	54 (18-82)	46 (18-72)	< 0.001
Gender (male, %)	736 (67.5)	80 (53.3)	0.001
Etiology
ALD (%)	345 (31.7)	18 (12.0)	< 0.001
Viral (%)	303 (27.8)	50 (33.3)	0.159
Cholestatic and autoimmune (%)	227 (20.8)	34 (22.7)	0.604
Clinical
Na, mmol/L	135 (116-151)	138 (118-150)	< 0.001
Creatinine, mg/dL	1.0 (0.4-6.8)	1.3 (0.7-8.3)	< 0.001
Bilirubin, mg/dL	2.7 (0.2-68.4)	4.7 (0.4-56.3)	< 0.001
INR	1.3 (0.8-5.0)	1.2 (0.8-13.0)	0.078
MELD	14 (6-40)	20 (6-40)	< 0.001
UKELD	55 (43-77)	56 (44-79)	0.041
Ascites (%)	669 (62.9)	38 (25.5)	< 0.001
Encephalopathy (%)	350 (33.0)	52 (34.9)	0.637

ALD: Alcohol-related liver disease; INR: International normalised ratio; MELD: Model for end-stage liver disease; UKELD: United Kingdom end-stage liver disease model; PLT: Primary liver transplantation; LRT: Liver retransplantation.

Table 2 Factors associated with waiting list mortality in liver retransplantation patients on univariate and multivariate Cox proportional hazard analysis

Variable	Univariate			Multivariate
	HR	95%CI	P value	HR	95%CI	P value
Age > 60 yr	2.959	0.550-3.896	0.048	3.102	1.015-9.484	0.047
DM	1.587	0.499-5.042	0.434
Renal impairment	4.771	1.496-15.217	0.008	3.802	1.147-12.603	0.029
CCI continuous	3.121	1.589-6.130	0.001	2.688	1.222-5.912	0.014
CCI dichotomous	6.528	1.472-28.962	0.014	5.475	1.177-25.464	0.030
Hb, g/dL	0.755	0.545-1.047	0.092
Platelet count, × 109/mL	0.994	0.986-1.001	0.090
Bilirubin, mg/dL	1.012	0.979-1.045	0.481
Creatinine, mg/dL	3.200	1.888-5.421	< 0.001	2.691	1.261-5.740	0.010
INR	1.489	1.055-2.102	0.024	1.406	0.967-2.044	0.075
Encephalopathy	2.049	0.620-6.770	0.239
Ascites	2.781	1.006-7.682	0.049
MELD	1.154	1.067-1.248	< 0.001	2.691	1.261-5.740	0.01
MELD ≥ 18	3.827	1.190-12.315	0.024	4.369	1.255-15.215	0.021
Na, mmol/L	0.945	0.870-1.027	0.180
UKELD	1.121	1.029-1.220	0.009	1.117	1.037-1.204	0.003

DM: Diabetes mellitus; CCI: Charlson comorbidity index; Hb: Haemoglobin; INR: International normalised ratio; MELD: Model for end-stage liver disease; Na: Serum sodium; UKELD: United Kingdom end-stage liver disease model.

Table 3 Univariate and multivariate analysis of factors associated with 1-year post-transplant patient and graft survival of retransplanted patients on Cox proportional hazard analysis

Variable	Patient survival			Graft survival
	HR	95%CI	P value	HR	95%CI	P value
Univariate analysis
Age	0.796	0.973-1.021	0.997	0.992	0.969-1.016	0.515
Early graft dysfunction	2.143	0.919-4.998	0.078	1.788	0.776-4.123	0.173
DM	2.242	0.961-5.228	0.062	2.004	0.869-4.618	0.103
Renal impairment	4.385	2.133-9.017	< 0.001	3.494	1.759-6.941	< 0.001
CCI continuous	3.344	1.949-5.738	< 0.001	2.755	1.638-4.633	< 0.001
CCI dichotomous	3.56	1.691-7.493	0.001	2.751	1.377-5.494	0.004
Pre-LRT mechanical ventilation	3.044	1.461-6.342	0.003	2.456	1.210-4.983	0.013
Pre-LRT vasopressor support	4.714	2.239-9.928	< 0.001	3.618	1.758-7.443	< 0.001
Pre-LRT renal replacement therapy	4.233	2.029-8.829	< 0.001	3.271	1.630-6.562	0.001
Transplant from ICU	2.744	1.318-5.712	0.007	2.101	1.049-4.206	0.036
MELD score ≥ 18	4.714	2.239-9.928	0.009	3.105	1.399-6.890	0.005
Encephalopathy at LRT	2.593	1.213-5.544	0.014	2.28	1.121-4.639	0.023
Hb, g/dL	0.791	0.629-0.994	0.044	0.792	0.636-0.985	0.037
ABO mismatch	2.37	1.015-5.532	0.046	2.338	1.053-5.190	0.037
Cold ischemia time (h)	1.113	0.987-1.255	0.082	1.081	0.962-1.216	0.191
DRI	0.68	0.236-1.963	0.476	0.693	0.250-1.918	0.476
DRI > 1.8	1.736	0.772-3.902	0.180	1.67	0.747-3.737	0.212
Multivariate analysis
Renal impairment	3.215	1.147-12.603	0.005	2.543	1.160-5.573	0.020
CCI Continuous	2.823	1.563-5.101	0.001	2.350	1.331-4.148	0.003
CCI Dichotomous	2.87	1.306-6.307	0.009	2.223	1.067-4.633	0.033
Pre-LRT mechanical ventilation	2.52	1.126-5.637	0.024	2.099	0.968-4.552	0.060
Pre-LRT vasopressor support	4.004	1.554-10.314	0.004	3.023	1.216-7.514	0.017
Pre-LRT renal replacement therapy	2.691	1.261-5.740	0.01	2.441	1.107-5.383	0.027
Transplant from ICU	1.859	0.794-4.354	0.153	1.437	0.640-3.230	0.380
MELD score ≥ 18	2.506	1.044-6.018	0.04	2.512	1.098-5.743	0.029
Encephalopathy at LRT	1.922	0.856-4.315	0.113	1.626	0.752-3.515	0.217
Hb, g/dL at LRT	0.883	0.694-1.125	0.314	0.883	0.698-1.116	0.297
ABO mismatch	1.795	0.739-4363	0.197	1.827	0.791-4.220	0.158

DM: Diabetes mellitus; LRT: Liver retransplant; ICU: Intensive care unit; CCI: Charlson comorbidity index; Hb: Haemoglobin; INR: International normalised ratio; MELD: Model for end-stage liver disease; DRI: Donor risk index.

Table 4 Comparison of prognostic variables according to time interval of liver retransplantation

Time between transplants (d)	0-7 (n = 19)	8-30 (n = 16)	> 30 (n = 86)	P value
Age	54 (18-67)	44 (20-63)	43 (19-70)	0.086
Transplant MELD	22 (10-40)	17 (8-36)	17 (6-31)	0.104
CCI ≥ 1, n (%)	10 (71)	11 (61)	44 (49)	0.095
Indication, n (%)
Early graft dysfunction	14 (74)	2 (13)	2 (2)	< 0.001
Graft rejection	0 (0)	1 (6)	30 (35)	< 0.001
Vascular	5 (26)	13 (81)	23 (27)	< 0.001
Disease recurrence	0 (0)	0 (0)	24 (28)	0.001
Other indications	0 (0)	0 (0)	7 (8)	0.106

CCI: Charlson comorbidity index; MELD: Model for end stage liver disease.