Liver retransplantation in the era of machine perfusion

Objective: To compare perioperative and long-term graft and patient survival of liver retransplantation using static cold storage (SCS) and machine perfusion. Methods: We queried the UNOS database from 2018 to 2024 to analyze patients undergoing adult liver retransplantation alone. Logistic regression analyses were conducted for early graft loss (EGL), perioperative mortality at 30 and 90 days, and 1-year mortality. Results: We identified 1754 liver retransplants of which 100 were performed using machine perfusion. Median recipient age in the machine perfusion group was 54.0. Logistic regression analysis demonstrated 79.0% decrease in 30-day EGL ( p =0.02 OR 0.211) with improved 30- and 90-day mortality by 77.0% and 66.0% respectively ( p =0.03, OR 0.233, p =0.03, OR 0.343). SCS was associated with 69% increased risk of 1-year mortality ( p =0.01, OR, 0.306). Conclusion: Liver retransplantation outcomes are superior when machine perfusion preservation is used compared to SCS. Machine perfusion should be considered in all cases undergoing liver retransplantation.