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2017 ; 9
(8
): 427-435
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Factors associated with long-term survival after liver transplantation: A
retrospective cohort study
#MMPMID28357030
Pischke S
; Lege MC
; von Wulffen M
; Galante A
; Otto B
; Wehmeyer MH
; Herden U
; Fischer L
; Nashan B
; Lohse AW
; Sterneck M
World J Hepatol
2017[Mar]; 9
(8
): 427-435
PMID28357030
show ga
AIM: To identify predictive factors associated with long-term patient and graft
survival (> 15 years) in liver transplant recipients. METHODS: Medical charts of
all de novo adult liver transplant recipients (n = 140) who were transplanted in
Hamburg between 1997 and 1999 were retrospectively reviewed. In total, 155
transplantations were identified in this time period (15 re-transplantations).
Twenty-six orthotopic liver transplant (OLT) recipients were early lost to
follow-up due to moving to other places within 1 year after transplantation. All
remaining 114 patients were included in the analysis. The following recipient
factors were analysed: Age, sex, underlying liver disease, pre-OLT body mass
index (BMI), and levels of alanine aminotransferase (ALT), bilirubin, creatinine
and gamma-glutamyltransferase (gamma-GT), as well as warm and cold ischemia
times. Furthermore, the following donor factors were assessed: Age, BMI, cold
ischemia time and warm ischemia time. All surviving patients were followed until
December 2014. We divided patients into groups according to their underlying
diagnosis: (1) hepatocellular carcinoma (n = 5, 4%); (2) alcohol toxic liver
disease (n = 25, 22.0%); (3) primary sclerosing cholangitis (n = 6, 5%); (4)
autoimmune liver diseases (n = 7, 6%); (5) hepatitis C virus cirrhosis (n = 15,
13%); (6) hepatitis B virus cirrhosis (n = 21, 19%); and (7) other (n = 35, 31%).
The group "other" included rare diagnoses, such as acute liver failure, unknown
liver failure, stenosis and thrombosis of the arteria hepatica, polycystic liver
disease, Morbus Osler and Caroli disease. RESULTS: The majority of patients were
male (n = 70, 61%). Age and BMI at the time point of transplantation ranged from
16 years to 69 years (median: 53 years) and from 15 kg/m(2) to 33 kg/m(2)
(median: 24), respectively. Sixty-six OLT recipients (58%) experienced a
follow-up of 15 years after transplantation. Recipient's age (P = 0.009) and BMI
(P = 0.029) were identified as risk factors for death by ?(2)-test. Kaplan-Meier
analysis confirmed BMI or age above the median as predictors of decreased
long-term survival (P = 0.008 and P = 0.020). Hepatitis B as underlying disease
showed a trend for improved long-term survival (P = 0.049, ?(2)-test, P = 0.055;
Kaplan-Meier analysis, Log rank). Pre-transplant bilirubin, creatinine, ALT and
gamma-GT levels were not associated with survival in these patients of the
pre-era of the model of end stage liver disease. CONCLUSION: The recipients' age
and BMI were predictors of long-term survival after OLT, as well as hepatitis B
as underlying disease. In contrast, donors' age and BMI were not associated with
decreased survival. These findings indicate that recipient factors especially
have a high impact on long-term outcome after liver transplantation.