Risk factors of adult recipient survival beyond 20 years since liver transplantation: retrospective cohort study

Long-term recipient survival post-liver transplant (LT) has not significantly improved over time due to the presence of deleterious risk factors and multiple complications. We analyzed the causes of death and risk factors of patient survival beyond, at least, a 20-year follow-up.

This retrospective cohort study comprised 409 adult patients who underwent LT between January 1990 and March 2005. 126 recipient survivors for, at least, a 20-year follow-up, were compared with 283 non-survivors.

Median age was significantly higher in non-survivors than in survivors (47-year vs 57-year; p < 0.001). Most common indications of LT were alcoholic cirrhosis, HCV or HBV cirrhosis and hepatocellular carcinoma. Intraoperative blood (p = 0.005) and plasma (p = 0.002) transfusion were significantly higher in non-survivors. The rates of hepatic artery thrombosis/stenosis and primary non-function were significantly higher in non-survivors. The median follow-up period of the survivors was 23.7 (20-34.3) years vs 6.2 (0-29.5) years in non-survivors (p < 0.001). A significantly higher incidence of renal insufficiency (p < 0.001) and respiratory complications (p = 0.001) were seen in non-survivors. The commonest causes of death beyond a 20-year follow-up were hepatic failure (33.6%), de novo tumors (22.2%), cardiovascular (18.7%), infection (14.8%), hepatocarcinoma recurrence (2.5%), and pulmonary (2.1%). Patient survival at 20 and 30 years after LT were 37.7%, and 27.3%, respectively. Advanced recipient age, intraoperative blood transfusion and post-LT renal insufficiency were risk factors for recipient survival beyond, at least, 20 years since LT.

Thirty-year patient survival post-LT was 27.3%. Advanced recipient age, intraoperative blood transfusion and post-renal insufficiency were risk factors for survival.