Factors associated with long-term survival after liver transplantation: A retrospective cohort study

Abstract

AIMTo identify predictive factors associated with long-term patient and graft survival (> 15 years) in liver transplant recipients.METHODSMedical charts of all de novo adult liver transplant recipients (n = 140) who were transplanted in Hamburg between 1997 and 1999 were retrospectively reviewed. In total, 155 transplantations were identified in this time period (15 re-transplantations). Twenty-six orthotopic liver transplant (OLT) recipients were early lost to follow-up due to moving to other places within 1 year after transplantation. All remaining 114 patients were included in the analysis. The following recipient factors were analysed: Age, sex, underlying liver disease, pre-OLT body mass index (BMI), and levels of alanine aminotransferase (ALT), bilirubin, creatinine and gamma-glutamyltransferase (gamma-GT), as well as warm and cold ischemia times. Furthermore, the following donor factors were assessed: Age, BMI, cold ischemia time and warm ischemia time. All surviving patients were followed until December 2014. We divided patients into groups according to their underlying diagnosis: (1) hepatocellular carcinoma (n = 5, 4%); (2) alcohol toxic liver disease (n = 25, 22.0%); (3) primary sclerosing cholangitis (n = 6, 5%); (4) autoimmune liver diseases (n = 7, 6%); (5) hepatitis C virus cirrhosis (n = 15, 13%); (6) hepatitis B virus cirrhosis (n = 21, 19%); and (7) other (n = 35, 31%). The group “other” included rare diagnoses, such as acute liver failure, unknown liver failure, stenosis and thrombosis of the arteria hepatica, polycystic liver disease, Morbus Osler and Caroli disease.RESULTSThe majority of patients were male (n = 70, 61%). Age and BMI at the time point of transplantation ranged from 16 years to 69 years (median: 53 years) and from 15 kg/m2 to 33 kg/m2 (median: 24), respectively. Sixty-six OLT recipients (58%) experienced a follow-up of 15 years after transplantation. Recipient’s age (P = 0.009) and BMI (P = 0.029) were identified as risk factors for death by χ2-test. Kaplan-Meier analysis confirmed BMI or age above the median as predictors of decreased long-term survival (P = 0.008 and P = 0.020). Hepatitis B as underlying disease showed a trend for improved long-term survival (P = 0.049, χ2-test, P = 0.055; Kaplan-Meier analysis, Log rank). Pre-transplant bilirubin, creatinine, ALT and gamma-GT levels were not associated with survival in these patients of the pre-era of the model of end stage liver disease.CONCLUSIONThe recipients’ age and BMI were predictors of long-term survival after OLT, as well as hepatitis B as underlying disease. In contrast, donors’ age and BMI were not associated with decreased survival. These findings indicate that recipient factors especially have a high impact on long-term outcome after liver transplantation.

Liver transplantation and alcoholic liver disease: History, controversies, and considerations

“…The ELTR evaluated 121,546 patients who underwent LT in 1968-2015 in Europe, and the study found that the survival rates for AC patients ( n = 22648) at 1, 5 and 10 years after LT were 86%, 73%, and 59%, respectively. These rates were greater than those observed for patients with HCV (80%, 65%, and 53%), HCC (83%, 62%, and 49%), acute liver failure (70%, 64%, and 58%), and hemochromatosis (76%, 66%, and 53%); similar to those observed for patients with AC plus HCV or HBV (85%, 69%, and 54%); and a little lower than those observed for patients with cholestasis (87%, 78%, and 70%), autoimmune hepatitis (85%, 76%, and 67%), and HBV (83%, 74%, and 68%) (Figure 2 )[ 197 , 198 ].…”

Life Expectancy After Liver Transplantation for Hepatocellular Carcinoma With Cirrhosis

“…For example, Bouami et al, 26 (Figure 2A, p503) shows median survival times of 9 years for patients aged 56 and over, and 14 years for those aged 47-55. Also, Pischke et al, 27 (Figure 2A, p431) indicates a median of 13 years for patients older than age 53. The corresponding life expectancies would be several years higher than these medians, and thus keeping with the results shown in Table 2, for example, though neither of the aforementioned studies is specific to HCC patients.…”

Influence of postoperative complications on long-term survival in liver transplant patients

“…Postoperative complications are frequent and often severe after liver transplantation. Many of them lead to intervention, reoperation, retransplantation and even death[ 15 ]. The postoperative mortality of the present study was 7.9%, similar to other European series -8-20%-[ 16 , 17 ] and according to the standard of the Spanish Society of LT[ 18 ].…”