Decision-making Tool for Early Liver Retransplantation: The Early Liver Retransplantation Score

BACKGROUND: Retransplantation (ReLT) is the only therapeutic option to treat early liver graft failure and to achieve the best graft/recipient combination that is essential to optimize patient and graft survival. This national study aimed to establish a donor and a recipient early liver retransplantation score (ELRS) to predict the risk of graft loss after early ReLT. METHODS: Using the French national transplantation database, we analyzed all adult recipients who underwent a first or a second ReLT between 2007 and 2022 within the first 90 d post-liver transplantation (N = 477). Patients were randomly divided into derivation (DC) and validation cohorts (VC). A global transplant risk score was first derived from the DC using variables from donors and recipients using a Cox model and then tested in the VC. Two separate recipient and donor-risk scores have been built from this global score and were used to assess donor-recipient matching. RESULTS: The factors at ReLT associated with 1-y graft loss were: for the donor: age >70 y, arterial hypertension, BMI >25 kg/m 2 ; for the recipient: absence of hepatic artery thrombosis, mechanical ventilation, glomerular filtration rate <60 mL/min, ReLT after day 8 post-LT, and the presence of at least 1 complication at ReLT. Correlation between observed and predicted graft loss rate was close for the VC (r = 0.8). Four risk levels ranging from 48% to 79% 1-y graft survival were identified from the matching of donor and recipient scores. CONCLUSIONS: ELRS provides a decision-making tool to guide clinicians through the selection of candidates for early ReLT and to optimize donor-recipient matching to reduce the risk of graft loss.