Utilization and Outcomes of Rescue Hepatectomy Among U.S. Liver Retransplant Candidates.

The frequency and outcomes of anhepatic patients listed for transplantation in the United States have not been studied. The United Network for Organ Sharing (UNOS) records anhepatic status for patients listed as Status 1A for hepatic artery thrombosis (HAT) or primary non-function (PNF). Using the UNOS database from 2005-2020, demographics and waitlist outcomes of anhepatic candidates relisted as Status 1A for HAT or PNF were assessed. Among 1,364 adult Status 1A patients relisted for PNF or HAT across 120 distinct transplant centers, 75 (5.5%) patients were anhepatic and 1,289 (94.5%) were non-anhepatic. A substantial number of centers (n = 51) had experience with ≥1 anhepatic patient relisted for either PNF or HAT, with individual center rates ranging from 0%-11.4%. Waitlist mortality was more than twice as high for anhepatic patients: 42.5% vs 17.0% non-anhepatic patients (p<0.001). The post-transplant outcomes of anhepatic patients were markedly inferior to non-anhepatic patients. For example, 41.9% of anhepatic patients died during the index admission versus 23.4% of the non-anhepatic group (p = 0.006). Patient survival for the anhepatic and non-anhepatic groups was 48.3 vs. 66.2% at one-year and 29.3 vs. 46.2% at 5-years, respectively (log-rank test for overall survival p = 0.014). Rescue hepatectomy after initial liver transplantation is not only associated with high waitlist mortality, but also markedly worse post-transplant outcomes. With less than half of anhepatic patients surviving to the first year post-LT, further research is warranted to better delineate which patients should be considered for rescue hepatectomy. This article is protected by copyright. All rights reserved.