{
  "abstract": "Introduction Liver transplantation (LT) is currently the life-saving therapeutic modality for patients with end-stage liver disease, with 5- and 10-year survival rates of over 70% and 65% respectively, with re-transplantation rates varying between 5% and 22% worldwide. The requirement of a 3rd graft remains rare however occurs, with our center publishing 3rd grafts comprising 0.25% of the total LT volume (1982-2007). Donor age >55 and MELD </= 23 were poor prognosticators with no patients surviving > 3years (due to death/limited FU). We aim to investigate the outcomes of patients after the 3rd Liver graft and the factors affecting their survival.Methods This is a retrospective cohort study of the long-term outcomes of patients who underwent a third LT at the Birmingham Liver Unit, UK (June 1986-2022). Between June 1986 to July 2022, a total 76 patients underwent a third liver grafting at our center. Follow up was till death, retransplant (4 th graft) or last follow-up. Graft cirrhosis was defined by radiological, histological or clinical diagnosis. Post 3rd LT ‘early death’ was defined as death withing 90d of transplant.Results The median age of the patients at the third transplant was 29.5 years (IQR 19.2-42), with 40% male patients. Indications included: Hepatic artery thrombosis (HAT) (36.8%), followed by chronic rejection (22.4%), and recurrent PSC (10.5%). Our cohort’s median UKELD score was 56.5 (IQR 51.5-61.5). 84% of the patients received DBD graft, with a median donor age of 44.5 years (IQR 34.5 – 49) and a median cold ischemic time of 8.33 hours (IQR 6.87 – 9.5).On follow up, graft cirrhosis developed in 29% of the patients during the follow-up, and 25% of the patients were officially assessed for the fourth graft.Patient survival at 1-,3-,5- and 10- years was 48%, 40%, 32%, and 20%, respectively post 3rd graft. 50% of the deaths occurred in the first 3 months post-3rd graft. *Female gender (OR 3.87; 95% CI: 1.2-12.9, p=0.02), less than one month since the 2nd LT (OR 3.9; 95% CI 1.3-11.3, p=0.01) and on being on renal replacement therapy at the time of 3rd LT transplant (OR 19.9, CI: 5.1-78.4, P<0.001) were significantly associated with increased risk of early post third LT mortality. Older age (Age >40 years) and underlying indication for the third transplant were not associated with adverse outcomes.Conclusions 3rd LT remains challenging and offers modest survival benefits with less than 50% patients surviving to 5 years and half of deaths occurring within 90 days due to... Appropriate patient selection may allow more precision-based decision making.",
  "authors": [
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, Sutton Coldfield, United Kingdom"
      ],
      "name": "Muhammad Umair Khan"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, Sutton Coldfield, United Kingdom"
      ],
      "name": "Mujeeb Ullah Makki"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, Sutton Coldfield, United Kingdom"
      ],
      "name": "Matt Armstrong"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, Sutton Coldfield, United Kingdom"
      ],
      "name": "Nick Murphy"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, Sutton Coldfield, United Kingdom"
      ],
      "name": "Rebecca Sanbria Mateos"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, Sutton Coldfield, United Kingdom"
      ],
      "name": "Neil Rajoriya"
    }
  ],
  "title": "P87 Outcomes of patients after 3rd liver transplant - an update",
  "uid": "fa6ab79e-8c14-586f-973c-263393ac1b91"
}