Post-liver transplant mortality in Canada: A retrospective analysis and quality assurance study in British Columbia

Liver transplantation is a life-saving treatment for end-stage liver disease, significantly improving survival. In Canada, the number of liver transplants has increased, with British Columbia performing 107 transplants in 2023. One-year survival rates have risen from 74.8% in 1990 to 93.2% in 2021 due to advancements in surgical and immunosuppressive methods. However, long-term survival remains suboptimal, with malignancy, graft failure, and cardiovascular disease being key contributors to mortality. This study analyzed causes of mortality among liver transplant recipients in British Columbia to identify strategies for improving outcomes.

This retrospective study included 314 deceased liver transplant recipients (age ≥18 years) in British Columbia between 2013 and 2023, using the BC Transplant database. Statistical analyses included descriptive statistics, Kruskal-Wallis survival analysis, and linear regression, with significance set at p < 0.05.

Malignancy was the leading cause of death (24.8%), followed by unknown causes (19.4%) and multi-organ failure (13.1%). One-year survival rates varied significantly by cause of death (p = 0.018), with malignancy having the highest 1-year survival (94.9%) and septicemia the lowest (73.5%). Younger recipients had longer survival times (r = -0.321, p < 0.001), while multiple transplants were associated with poorer outcomes (ρ = -0.252, p < 0.001).

Malignancy remains the most frequent cause of death post-transplant, requiring enhanced surveillance. The significant variability in 1-year survival by cause of death highlights the need for tailored interventions, particularly to reduce sepsis-related mortality. Improved documentation of unknown causes is critical to optimizing long-term strategies.