Long-term follow-up after liver transplantation in patients with hepatic iron overload

Abstract

Patients with hepatic iron overload who undergo orthotopic liver transplantation (OLT) have a worse 1-year survival than those who undergo transplantation for other indications; the long-term outcome in this population is unknown. The purpose of this study is to report long-term follow-up after OLT in a cohort of patients with hepatic iron overload. Five liver transplant centers in the United States reported follow-up data on 37 patients receiving a first liver transplant who had severe hepatic iron overload in their native livers. KaplanMeier 5-year survival among these patients was compared with survival data from all age-matched liver transplantations reported to the United Network for Organ Sharing (UNOS) over the same time period (1987 to 1993). The 5-year survival rate after OLT was 40% in the hepatic iron overload group compared with an overall survival rate of 62% for all patient groups from the UNOS registry (P ‫؍‬ .0009). Although sepsis was the cause of 53% of all deaths occurring within the first year after OLT, cardiac complications accounted for 50% of the late mortality in patients with hepatic iron overload. In conclusion, longterm survival after OLT is significantly decreased in patients with hepatic iron overload. Infectious and cardiac complications are the most common causes of death in these patients. Further studies are needed to define the relationship between hepatic iron overload and mortality and to examine the effect of iron depletion on outcome after OLT in this patient population.

Recurrence of non-viral liver disease after orthotopic liver transplantation

“…This included three myocardial infarctions, one case of congestive heart failure and 1 cardiac arrest in the setting of renal failure. Cardiac complications were more common 1 year after OLT, accounting for four out of eight deaths (136). In a series of nine patients undergoing OLT for haemochromatosis, eight patients developed cardiac complications including an intraoperative pulmonary embolus in one patient, congestive heart failure in three patients and arrhythmia in four patients (136).…”

Liver allograft iron accumulation in patients with and without pretransplantation hepatic hemosiderosis

“…Several studies have reported that post-OLT survival is worse in patients with HHC compared with those who underwent OLT for other indications. [1][2][3][4][5][6] Decreased survival in patients who underwent OLT for HHC was related to an increased number of infections and cardiac complications. In one study, reduced survival in patients who underwent OLT with iron overload was independent of HFE gene status.…”

Liver transplantation for hereditary hemochromatosis

“…36 A follow-up study of the same patients that reported 5-year survival analyzed the cause of death in relation to time from OLT. 38 Sepsis was the cause of 53% of deaths within the first year post-OLT, whereas cardiac complications were responsible for 50% of deaths after 1 year. Of the 8 patients who died of sepsis within the first year after OLT, sepsis was caused by a bacterial source in 4 patients, candida in 1 patient, and unknown in 3 patients.…”

“…38 This included 3 myocardial infarctions, 1 case of congestive heart failure, and 1 cardiac arrest in the setting of renal failure. Separated by early (Ͻ1 year post-OLT) or late (Ͼ1 year post-OLT) deaths, cardiac complications were more common in the late group.…”

“…One-and 5-year post-OLT survival did not differ in patients with HHC with and without primary liver cancer. 36,38 In a series of 9 patients with HHC undergoing OLT, 2 incidental primary liver cancers (1 HCC, 1 cholangiocarcinoma) were detected. 37 The patient with cholangiocarcinoma died of metastatic disease.…”