Survival outcomes following liver retransplantation (reSOFT) score: A model predicting survival after adult liver retransplantation

Recipient and donor risk factors impacting adult liver retransplantation remain inadequately described in the modern era of liver transplantation. Our study aimed to develop a risk model for 3-month recipient survival following liver retransplantation using data from the Organ Procurement and Transplantation Network's (OPTN) liver transplantation database. We conducted univariate and multivariable analyses on 6660 adult patients who underwent liver retransplantation between 2002 and 2023. Multiple imputation was also conducted to account for missing variables. From our analysis, we identified 14 recipient factors, 1 donor factor (age), and 1 operative factor (cold ischemia time) that significantly impacted 3-month patient survival. Among the most significant risk factors were a functional status, measured by the Karnofsky Score, of 10% at retransplantation (OR: 1.80, 95% CI: 1.44-2.24) and recipient albumin of <1.5 (OR: 1.76, CI: 1.12-2.77). The most significant protective factors included a functional status of 90% (OR: 0.22, CI: 0.07-0.70) and recipients with a history of HCC (OR: 0.10, CI: 0.01-0.79). The reSOFT score was developed by assigning points to these factors proportional to their hazard ratios and divided into high-, moderate-, and low-risk groups that accurately predict 3-month survival post-retransplant. With a C-statistic of 0.73 (CI: 0.71-0.75), this tool may serve to guide clinicians in identifying and better caring for high-risk retransplant recipients.