Analysis of adult 20-year survivors after liver transplantation

Abstract

BackgroundLiver transplantation (LT) is the treatment of choice for chronic and acute liver failure; however, the status of long-term survivors and allograft function is not well known.AimTo evaluate the clinical outcome and allograft function of survivors 20 years post-LT, cause of death during the same period and risk factors of mortality.MethodsA retrospective study was conducted from prospective, longitudinal data collected at a single center of adult LT recipients surviving 20 years. A comparative sub-analysis was made with patients who were not alive 20 years post-transplantation to identify the causes of death and risk factors of mortality.ResultsBetween 1988 and 1994, 132 patients received 151 deceased-donors LT and 28 (21 %) survived more than 20 years. Regarding liver function in this group, medians of AST, ALT and total bilirubin at 20 years post-LT were 33 IU/L (13–135 IU/L), 27 (11–152 IU/L) and 0.6 mg/dL (0.3–1.1 mg/dL). Renal dysfunction was observed in 40 % of patients and median eGFR among 20-year survivors was 64 mL/min/1.73 m2 (6–144 mL/min/1.73 m2). Sixty-one percent of 20-year survivors had arterial hypertension, 43 % dyslipidemia, 25 % de novo tumors and 21 % diabetes mellitus. Infections were the main cause of death during the 1st year post-transplant (32 %) and between the 1st and 5th year post-transplant (25 %). After 5th year from transplant, hepatitis C recurrence (22 %) became the first cause of death. Factors having an impact on long-term patient survival were HCC indication (p = 0.049), pre-transplant renal dysfunction (p = 0.043) and long warm ischemia time (p = 0.016); furthermore, post-transplant factors were diabetes mellitus (p = 0.001) and liver dysfunction (p = 0.05) at 1 year.ConclusionOur results showed the effect of immunosuppression used during decades on long-term outcome in our LT patients in terms of morbidity (arterial hypertension, diabetes mellitus, dyslipidemia and renal dysfunction) and mortality (infections and hepatitis C recurrence).

Transplantation of Deceased Donor Livers With Elevated Levels of Serum Transaminases at Shiraz Transplant Center

“…The decisions of using these grafts were made by the surgeon due to organ shortage at our center, critical conditions of the recipients, and the overall conditions of the donors and the grafts. The one-year survival rate and the rates of post-transplant vascular, biliary and infectious complications in the case group were comparable to that of the control group and the data of recipients, who received liver grafts with normal levels of serum transaminases in the literature (12, 13). Denoting that the levels of serum AST and/or ALT of deceased liver donors of more than 500 IU/L may not adversely affect the final outcome and survival of the recipients.…”

Trasplante hepático: evolución, curva de aprendizaje y resultados después de los primeros 300 casos

“…Enfermedades históricamente conocidas como las principales indicaciones de TH como las cirrosis virales hepatitis B y C o las patologías agrupadas de origen autoinmunitario 13,17,40,[42][43][44] fueron reemplazadas por la cirrosis NASH en nuestra serie. Hecho concordante con el paulatino aumento de esta enfermedad a lo largo de los años 40,45,46 .…”

Untitled

“…3 Dyslipidemia was diagnosed as cholesterol of more than 220 mg/dL and triglyceride of more than 200 mg/dL at 2 consecutive visits. 4 Statistical analyses were performed with SPSS software (SPSS: An IBM Company, version 20.0, IBM Corporation, Armonk, NY, USA). Results are presented as means ± standard deviation for quantitative data or as numbers with percentages for qualitative data.…”