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Factors associated with long-term survival after liver transplantation: A retrospective cohort study
Sven Pischke1, Marie C Lege1, Moritz von Wulffen1
1Sven Pischke, Marie C Lege, Moritz von Wulffen, Antonio Galante, Benjamin Otto, Malte H Wehmeyer, Ansgar W Lohse, Martina Sterneck, Department of Medicine I, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
Insights
Recipient age and BMI are key predictors of long-term survival after liver transplantation. Hepatitis B as an underlying condition also showed a trend towards improved outcomes in liver transplant recipients.
Area of Science:
- Hepatology and Transplant Surgery
- Clinical Outcomes Research
Background:
- Long-term survival following liver transplantation is crucial for patient outcomes.
- Identifying predictive factors for long-term success is essential for optimizing patient selection and management.
Purpose of the Study:
- To identify predictive factors associated with long-term patient and graft survival (> 15 years) in liver transplant recipients.
- To analyze the impact of recipient and donor characteristics on post-transplant outcomes.
Main Methods:
- Retrospective review of medical charts of 114 adult de novo liver transplant recipients transplanted between 1997 and 1999.
- Analysis of recipient factors (age, BMI, underlying liver disease) and donor factors (age, BMI).
- Kaplan-Meier analysis and Chi-squared tests were used to assess survival predictors.
Main Results:
- Recipient age and body mass index (BMI) were identified as significant risk factors for mortality.
- Higher recipient age and BMI above the median were associated with decreased long-term survival.
- Hepatitis B as the underlying liver disease showed a trend towards improved long-term survival.
Conclusions:
- Recipient age and BMI are significant predictors of long-term survival after orthotopic liver transplantation (OLT).
- Hepatitis B as an underlying condition may be associated with improved long-term outcomes.
- Recipient factors, rather than donor factors, appear to have a substantial impact on long-term liver transplant outcomes.
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/m2 to 33 kg/m2 (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 χ2-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, χ2-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.