Trajectories of patients relisted for liver transplantation

Fakhar Ali Qazi Arisar, Rhea Varghese, Shiyi Chen, Wei Xu, Markus Selzner, Ian McGilvray, Blayne Sayed, Trevor Reichman, Chaya Shwaartz, Mark Cattral, Anand Ghanekar, Gonzalo Sapisochin, Elmar Jaeckel, Cynthia Tsien, Nazia Selzner, Leslie Lilly, Mamatha Bhat*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Introduction and Objectives: Recurrent cirrhosis complicates 10-30% of Liver transplants (LT) and can lead to consideration for re-transplantation. We evaluated the trajectories of relisted versus primary listed patients on the waitlist using a competing risk framework. Materials and Methods: We retrospectively examined 1,912 patients listed for LT at our centre between from 2012 to 2020. Cox proportional hazard models were used to assess overall survival (OS) by listing type and competing risk analysis Fine-Gray models were used to assess cumulative incidence of transplant by listing type. Results: 1,731 patients were included (104 relisted). 44.2% of relisted patients received exception points vs. 19.8% of primary listed patients (p<0.001). Patients relisted without exceptions, representing those with graft cirrhosis, had the worst OS (HR: 4.17, 95%CI 2.63 – 6.67, p=<0.0001) and lowest instantaneous rate of transplant (HR: 0.56, 95%CI 0.38 – 0.83, p=0.006) than primary listed with exception points. On multivariate analysis listing type, height, bilirubin and INR were associated with cumulative incidence of transplant, while listing type, bilirubin, INR, sodium, creatinine were associated with OS. Within relisted patients, there was a trend towards higher mortality (HR: 1.79, 95%CI 0.91 – 3.52, p=0.08) and low transplant incidence (HR: 0.51, 95%CI 0.22 – 1.15, p=0.07) for graft cirrhosis vs other relisting indications. Conclusions: Patients relisted for LT are carefully curated and comprise a minority of the waitlist population. Despite their younger age, they have worse liver/kidney function, poor waitlist survival, and decreased transplant incidence suggesting the need for early relisting, while considering standardized exception points.

Original languageEnglish
Article number101168
JournalAnnals of Hepatology
Issue number1
StatePublished - 1 Jan 2024
Externally publishedYes


  • Donor allocation
  • Exception points
  • Graft cirrhosis
  • Graft failure
  • Re-transplant
  • Waitlist outcomes


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