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Equivalent Outcomes With Retransplantation and Primary Liver Transplantation in the Direct-acting Antiviral Era

Croome, Kristopher P., MD1; Mathur, Amit K., MD2; Pungpapong, Surakit, MD1; Lee, David D., MD1; Moss, Adyr A., MD2; Rosen, Charles B., MD3; Heimbach, Julie K., MD3; Taner, C. Burcin, MD1

doi: 10.1097/TP.0000000000002460
Original Clinical Science—Liver

Background. The present multicenter study investigated whether equivalent outcomes to primary liver transplant (LT) could be achieved with liver retransplant (reLT) and whether improvements in outcomes have taken place over time, particularly in the direct-acting antiviral era.

Methods. All reLT performed at Mayo Clinic Florida, Mayo Clinic Rochester, and Mayo Clinic Arizona were divided into era 1 (2002–2007), era 2 (2008–2012), and era 3 (2013–2017) based on the date of reLT.

Results. Improvement in graft survival (GS) after reLT was seen over the 3 eras (P < 0.001). In era 1, GS after reLT was inferior to primary LT (P < 0.001), whereas no difference was seen between reLT and primary LT in era 2 (P = 0.68) or era 3 (P = 0.36). A significantly higher proportion of patients achieved sustained viral response (SVR) within the first year after reLT in each subsequent era (era 1: 10.3%, era 2: 22.5%, and era 3: 100%) (P < 0.001). Graft survival was superior in patients undergoing reLT for recurrent hepatitis C virus who achieved SVR after reLT compared with those who did not (P = 0.03).

Conclusions. Results similar to primary LT were achieved in era 3. These improvements coincide with the availability of direct-acting antivirals, which resulted in a 100% SVR rate in era 3 and a decrease in the number of patients undergoing reLT for recurrent hepatitis C virus. The historic dogma that reLT results in inferior outcomes should be revisited.

1 Department of Transplant, Mayo Clinic Florida, Jacksonville, FL.

2 Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ.

3 Department of Surgery, Mayo Clinic Rochester, Rochester, MN.

Received 21 June 2018. Revision received 4 September 2018.

Accepted 8 September 2018.

The authors declare no funding or conflicts of interest.

K.P.C., A.K.M., A.A.M., C.B.R., J.K.H., C.B.T., D.D.L., S.P., and D.L. participated in research design. K.P.C. and C.B.T. participated in data analysis. K.P.C. and C.B.T. participated in the performance of the research. K.P.C., A.K.M., A.A.M., C.B.R., J.K.H.,C. B.T., and S.P. participated in the writing of the article.

Correspondence: C. Burcin Taner, MD, Department of Transplant, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224. (

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