Clinical outcome of 1,000 consecutive cases of liver transplantation: a single center experience

Abstract

Purpose: The aim of this study was to analyze survival outcomes in 1,000 consecutive liver transplantations (LTs) performed at a single institution from 1993 to April 2017.

Methods: The study population was divided into 2 groups based on donor type: deceased donor LT (DDLT; n = 181, 18.1%) and living donor LT (LDLT; n = 819; 81.9%), and into 3 periods based on the number of cases (first 300 cases, middle 300 cases, last 400 cases).

Results: Infection was the most common cause of death, accounting for 34.8% (95 of 273). Mortality due to hepatocellular carcinoma recurrence occurred most frequently between 1 and 5 years after transplantation. Mortality rate by graft rejection was highest between 5 and 10 years after transplantation. And mortality by de novo malignancy occurred most frequently after 10 years after transplantation. The patient survival rates for the entire population at 5 and 10 years were 74.7%, and 68.6%, respectively. There was no difference in survival rate between the LDLT and DDLT groups (P = 0.188). Cause of disease, disease severity, case period, and retransplantation had a significant association with patient survival (P = 0.002, P = 0.031, P = 0.003, and P = 0.024, respectively).

Conclusion: Surgical techniques and perioperative management for transplant patients have improved and undergone standardization. Controlling perioperative infection and managing patients with HCC as LT candidates will result in better outcomes.

Keywords: Cause of death; Liver transplantation; Risk factors; Survival.

Fig. 1. Overall survival analysis of 1,000 liver transplantations; overall survival in all cases (A), overall survival according to graft type (B) and overall survival in patients with hepatocellular carcinoma according to Milan criteria (C). LDLT, living donor liver transplantation; DDLT, deceased donor liver transplantation.

Fig. 2. Overall survival analysis of the 1,000 liver transplantations (LTs); causes of diseases (A), disease severity (B), case period (C), and primary versus retransplantation (D). Period 1: from June 1993 to May 2006; period 2: from May 2006 to April 2011; period 3: from April 2011 to April 2017.