Novel Benchmark Values for Redo Liver Transplantation: Does the Outcome Justify the Effort?,Annals of Surgery

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Novel Benchmark Values for Redo Liver Transplantation: Does the Outcome Justify the Effort?
Annals of Surgery ( IF 9 ) Pub Date : 2022-11-01 , DOI: 10.1097/sla.0000000000005634
Fariba Abbassi ₁ , Daniel Gero ₁ , Xavier Muller ₂ , Alba Bueno ₃ , Wojciech Figiel ₄ , Fabien Robin ₅ , Sophie Laroche ₆ , Benjamin Picard ₇ , Sadhana Shankar ₈ , Tommy Ivanics _{9,

10,

11} , Marjolein van Reeven ₁₂ , Otto B van Leeuwen ₁₃ , Hillary J Braun ₁₄ , Diethard Monbaliu ₁₅ , Antoine Breton ₂ , Neeta Vachharajani ₁₆ , Eliano Bonaccorsi Riani ₁₇ , Greg Nowak ₁₈ , Robert R McMillan ₁₉ , Samir Abu-Gazala ₂₀ , Amit Nair ₂₁ , Rocio Bruballa ₂₂ , Flavio Paterno ₂₃ , Deborah Weppler Sears ₂₄ , Antonio D Pinna ₂₄ , James V Guarrera ₂₃ , Eduardo de Santibañes ₂₂ , Martin de Santibañes ₂₂ , Roberto Hernandez-Alejandro ₂₁ , Kim Olthoff ₂₀ , R Mark Ghobrial ₁₉ , Bo-Göran Ericzon ₁₈ , Olga Ciccarelli ₁₇ , William C Chapman ₁₆ , Jean-Yves Mabrut ₂ , Jacques Pirenne ₁₅ , Beat Müllhaupt ₂₅ , Nancy L Ascher ₁₄ , Robert J Porte ₁₃ , Vincent E de Meijer ₁₃ , Wojciech G Polak ₁₂ , Gonzalo Sapisochin ₉ , Magdy Attia ₈ , Olivier Soubrane ₂₆ , Emmanuel Weiss ₇ , René A Adam ₆ , Daniel Cherqui ₆ , Karim Boudjema ₅ , Krzysztof Zieniewicz ₄ , Wayel Jassem ₃ , Philipp Dutkowski ₁ , Pierre-Alain Clavien ₁

Affiliation

Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
Department of General, Abdominal and Transplant Surgery, Croix-Rousse Hospital, Lyon, France.
Institute of Liver Studies, Kings' College Hospital, London, UK.
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
Department of HPB Surgery and Transplantation, University Hospital Rennes, Rennes, France.
Department of Surgery and Transplantation, the Hepatobiliary Center at Paul Brousse Hospital, Villejuif, France.
Department of Anesthesiology, Critical Care and Perioperative Medicine, DMU PARABOL, APHP.Nord, Hôpital Beaujon, Clichy, France.
Department of Abdominal Transplant and Hepatobiliary Surgery, The Leeds Teaching Hospital trust, Leeds, UK.
Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, ON, Canada.
Department of Surgery, Henry Ford Hospital, Detroit, MI.
Department of Surgical Sciences, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden.
Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Division of HPB Surgery and Liver Transplantation, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
Division of Transplant Surgery, University of California, San Francisco, CA.
Department of Abdominal Transplant Surgery and Transplant Coordination. University Hospitals Leuven, Leuven, Belgium.
Division of Abdominal Transplantation, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO.
Department of Abdominal and Transplant Surgery, University Hospital St. Luc, Brussels, Belgium.
Department of Transplantation Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Houston Methodist Hospital, Weill Cornell Medical Center, Houston, TX.
Department of Surgery, Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA.
Division of Transplantation and Hepatobiliary Surgery, University of Rochester, Rochester, MN.
HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Division of Liver Transplant, Rutgers New Jersey Medical School University Hospital, Newark, NJ.
Department of Abdominal and Transplant Surgery, Cleveland Clinic Florida, Weston, FL.
Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
Department of HPB surgery and liver transplantation, DMU DIGEST, APHP.Nord, Hôpital Beaujon, Clichy, France.

Objective:

To define benchmark cutoffs for redo liver transplantation (redo-LT).

Background:

In the era of organ shortage, redo-LT is frequently discussed in terms of expected poor outcome and wasteful resources. However, there is a lack of benchmark data to reliably evaluate outcomes after redo-LT.

Methods:

We collected data on redo-LT between January 2010 and December 2018 from 22 high-volume transplant centers. Benchmark cases were defined as recipients with model of end stage liver disease (MELD) score ≤25, absence of portal vein thrombosis, no mechanical ventilation at the time of surgery, receiving a graft from a donor after brain death. Also, high-urgent priority and early redo-LT including those for primary nonfunction (PNF) or hepatic artery thrombosis were excluded. Benchmark cutoffs were derived from the 75th percentile of the medians of all benchmark centers.

Results:

Of 1110 redo-LT, 373 (34%) cases qualified as benchmark cases. Among these cases, the rate of postoperative complications until discharge was 76%, and increased up to 87% at 1-year, respectively. One-year overall survival rate was excellent with 90%. Benchmark cutoffs included Comprehensive Complication Index CCI^® at 1-year of ≤72, and in-hospital and 1-year mortality rates of ≤13% and ≤15%, respectively. In contrast, patients who received a redo-LT for PNF showed worse outcomes with some values dramatically outside the redo-LT benchmarks.

Conclusion:

This study shows that redo-LT achieves good outcome when looking at benchmark scenarios. However, this figure changes in high-risk redo-LT, as for example in PNF. This analysis objectifies for the first-time results and efforts for redo-LT and can serve as a basis for discussion about the use of scarce resources.

中文翻译：

重做肝移植的新基准值：结果是否值得付出努力？

客观的：

定义再做肝移植(redo-LT) 的基准截止值。

背景：

在器官紧缺的时代，redo-LT 经常被讨论为预期的不良结果和资源浪费。然而，缺乏基准数据来可靠地评估重做 LT 后的结果。

方法：

我们从 22 个大容量移植中心收集了 2010 年 1 月至 2018 年 12 月期间的 redo-LT 数据。基准病例定义为终末期肝病模型 (MELD) 评分≤25、无门静脉血栓形成、手术时无机械通气、脑死亡后接受供体移植的受者。此外，排除了高紧急优先级和早期重做 LT，包括原发性无功能 (PNF) 或肝动脉血栓形成的那些。基准截止值来自所有基准中心中位数的第 75 个百分位数。

结果：

在 1110 个 redo-LT 中，373 个 (34%) 案例符合基准案例。在这些病例中，直至出院的术后并发症发生率为 76%，并且在 1 年时分别增加至 87%。一年总生存率非常好，达到 90%。基准截止值包括 1 年综合并发症指数 CCI ^® ≤72，住院死亡率和 1 年死亡率分别为 ≤13% 和 ≤15%。相比之下，因 PNF 而接受重做 LT 的患者表现出更差的结果，一些值明显超出重做 LT 基准。