Long-term survival after liver transplantation in 4,000 consecutive patients at a single center

Abstract

Objective: To evaluate the long-term survival outcomes of a large cohort of liver transplant recipients and to identify static and changing factors that influenced these outcomes over time.

Summary background data: Liver transplantation has been accepted as a therapeutic option for patients with end-stage liver disease since 1983, with continual improvements in patient survival as a result of advances in immunosuppression and medical management, technical achievements, and improvements in procurement and preservation. Although many reports, including registry data, have delineated short-term factors that influence survival, few reports have examined factors that affect long-term survival after liver transplantation.

Methods: Four thousand consecutive patients who underwent liver transplantation between February 1981 and April 1998 were included in this analysis and were followed up to March 2000. The effect of donor and recipient age at the time of transplantation, recipient gender, diagnosis, and year of transplantation were compared. Rates of retransplantation, causes of retransplantation, and cause of death were also examined.

Results: The overall patient survival for the entire cohort was 59%; the actuarial 18-year survival was 48%. Patient survival was significantly better in children, in female recipients, and in patients who received transplants after 1990. The rates of retransplantation for acute or chronic rejection were significantly lower with tacrolimus-based immunosuppression. The risk of graft failure and death was relatively stable after the first year, with recurrence of disease, malignancies, and age-related complications being the major factors for loss.

Conclusion: Significantly improved patient and graft survival has been observed over time, and graft loss from acute or chronic rejection has emerged as a rarity. Age-related and disease-related causes of graft loss represent the greatest threat to long-term survival.

Figure 1. Overall patient survival with comparison of male and female survival.

Figure 2. Survival according to era of transplantation.

Figure 3. Survival according to patient age.

Figure 4. Changes in death rates over time.

Figure 5. Graft survival according to (A) era, (B) gender, and (C) age distribution.

Figure 6. Changes in retransplantation rates according to (A) era, (B) indication for rejection, (C) indication for hepatic artery thrombosis, and (D) indication for primary nonfunction. Also shown is the increase in the rate of older donor use (E).

Figure 7. Patient survival after one, two, three, and more than three transplants at 1, 2, 5, and 10 years after transplantation.