An Analysis of Late Deaths After Liver Transplantation

Abstract

Late deaths (after more than 1 year) after liver transplantation were analyzed in a series of 464 consecutive patients who received liver grafts between 1982 and 1993. Recipients who survived the first posttransplant year (n = 365) had actuarial 5- and 10-year survival rates of 92% and 84%, respectively. Thirty-five patients died between 1.1 and 7.6 years after transplantation (mean, 3.2 +/- 1.9 years). The most common causes of death were related to immunosuppression (40%), namely, chronic rejection, opportunistic infection, and lymphoma. The second most common causes of death were related to the primary disease for which liver transplantation was performed (34.3%), mainly recurrence of hepatobiliary malignancy and hepatitis B. Eight patients (22.9%) died of unrelated and unpredicted causes, most commonly of cardiovascular disease. Although the survival of liver recipients who live beyond the first posttransplant year is excellent, control of rejection and the consequences of chronic immunosuppression are continual threats. Modification of immunosuppression may help in decreasing the mortality of long-term survivors. In addition, better selection of recipients and effective adjuvant therapies (antiviral and antineoplastic) are needed in patients in whom the primary liver disease is notorious for recurrence.

Longitudinal prospective evaluation of quality of life in adult patients before and one year after liver transplantation

“…13 The somatic symptoms that we found (excess appetite, trembling, and headaches) can be considered to be the side effects of immunosuppressive drugs. It was reported that deaths related to immunosuppressive treatments from chronic rejection, opportunist infections, and lymphoma represent 40% of late mortality after LT. 23 Pinson et al 24 are convinced that results of the QOL can be used similarly to the rate of rejection to determine immunosuppression regimen or other strategies of patient management. During recent years, a dramatic improvement has been achieved in the area of electronic data transmission.…”

Management of biliary problems after liver transplantation

“…However, they may still jeopardize the graft, resulting in graft loss in approximately 1% to 3% of transplant recipients. 5,11,12 …”

Long-term management of the liver transplant patient: Diabetes, hyperlipidemia, and obesity

“…1,2 As long-term liver transplant survival improves, cardiovascular complications are emerging as a major cause of both morbidity and mortality. In an early retrospective analysis of late deaths after liver transplantation, Asfar et al 3 found that of 365 patients who survived the first transplant year (from an original cohort of 465 consecutive patients), 35 patients died between 1.1 and 7.6 years after transplantation. Five of these late deaths (14%) were from cardiovascular disease, representing the third most common cause of late mortality, after recurrence of the primary liver disease and complications of immunosuppression.…”