To the Editor.
—In a recent article, Dr Ubel and colleagues1 argue that candidates for liver retransplant should receive a lower priority than candidates for primary transplant because of reduced 1-year survival.Looking at data in the aggregate may obscure important heterogeneities in retransplant candidates. For instance, Mora et al2 divided retransplant candidates into two groups—nonelective and elective. They found that there was no statistically significant difference in actuarial survival between patients who received elective retransplants and primary transplants; however, both groups did much better than the nonelective retransplant group. Elective retransplants were usually performed because of chronic rejection or hepatic artery thrombosis, whereas nonelective transplants often followed primary graft failure or acute rejection.Another possible heterogeneity applies to age group. For instance, although the data of Saito et al3 show a survival difference between first and second transplants, the difference is much less pronounced in children
McMasters R. Retransplantation of Scarce Organs: The Ethical Lessons. JAMA. 1994;271(15):1157. doi:10.1001/jama.1994.03510390027013