Analysis of long-term outcomes of 3200 liver transplantations over two decades: a single-center experience

Abstract

Objective: Few studies have evaluated long-term outcomes after orthotopic liver transplantation (OLT). This work analyzes the experience of nearly 2 decades by the same team in a single center. Outcomes of OLT and factors affecting survival were analyzed.

Methods: Retrospective analysis of 3200 consecutive OLTs that were performed at our institution, between February 1984 and December 31, 2001.

Results: Of 2662 recipients, 578 (21.7%) and 659 (24.7%) were pediatric and urgent patients, respectively. Overall 1-, 5-, 10-, and 15-year patient and graft survival estimates were 81%, 72%, 68%, 64% and 73%, 64%, 59%, 55%, respectively. Patient survival significantly improved in the second (1992-2001) versus the era I (1984-1991) of transplantation (P < 0.001). Similarly, graft survival was better in the era II of transplantation (P < 0.02). However, biliary and infectious complications increased in era II. When OLT indications were considered, best recipient survival was obtained in children with biliary atresia (82%, 79%, and 78% at 1, 5, and 10 years, respectively), while malignant disease in adult patients resulted in the worst outcomes of 68% and 43% at 1 and 5 years, post-OLT. Further, patients <18 years and nonurgent recipients exhibited superior survival when compared with recipients >18 years (P < 0.001) or urgent patients (P < 0.001). Of 13 donor and recipient variables, era of OLT, recipient age, urgent status, donor age, donor length of hospital stay, etiology of liver disease, retransplantation, warm and cold ischemia, but not graft type (whole, split, living-donor), significantly impacted patient survival.

Conclusions: Long-term benefits of OLT are greatest in pediatric and nonurgent patients. Multiple factors involving the recipient, etiology of liver disease, donor characteristics, operative variables, and surgical experience influence long-term survival outcomes. By balancing and matching these factors with a given recipient, optimum results can be achieved.

FIGURE 1. Number of yearly transplants performed in adults and pediatric recipients at UCLA.

FIGURE 2. Kaplan-Meier overall patient and graft survival estimates following 3200 liver transplantations in 2662 adult and pediatric recipients.

FIGURE 3. Patient survival estimates for different recipient populations based on (A) recipient age in years, (B) recipient urgent or nonurgent status, (C) donor age in years, and (D) requirement of renal graft.

FIGURE 4. Kaplan-Meier patient survival estimates for different etiologies of end stage liver disease. Survival for biliary atresia is given for pediatric recipients. Survival for all other etiologies is provided in adult patients.

FIGURE 5. Survival outcomes of liver transplantation in 2 different eras of transplantation. The era I extended from 1984 to 1991, while the second ranged from 1992 to 2001. A, Patient survival. B, Graft survival.

FIGURE 6. Survival estimates of recipients undergoing multiple liver transplantations. Recipient survival after primary OLT was compared with survival after retransplantation, 3 OLTs, or 4 OLTs.