Assessement of Survival and its Affecting Factors in Adult Liver Transplant Patients: A Retrospective Cohort Study

Liver disease is a leading cause of mortality among adults worldwide. Liver transplantation (LT) remains the only definitive treatment for patients with end-stage liver failure and has shown considerable success, particularly in high-volume centers in developing countries. Numerous factors can influence long-term survival following LT. This study aimed to identify the factors associated with survival among adult liver transplant recipients at Namazi Hospital, Shiraz between 2001 and 2018.

This retrospective cohort study included 3712 adult patients who underwent liver transplantation for advanced liver failure. Demographic and clinical data were extracted from medical records. Cox regression models were used to assess factors associated with post-transplant survival. Data was analyzed using the SPSS and R software.

Of the 3712 patients, 742 (20%) died during follow-up. Also, 2348 (63.3%) patients were male, and the mean (SD) age was 42.3 (13.2) years (range: 19-74 years). In the multivariable Cox model, re-transplantation, older recipient and donor age, higher Model for End-Stage Liver Disease (MELD) score, and certain etiologies of liver disease were significantly associated with poorer survival. Conversely, transplantation performed in 2010 or later was independently associated with improved survival outcomes.

Older recipient, donor age, and higher MELD score were independently associated with higher mortality after liver transplantation. Patients transplanted from 2010 onward experienced better survival, reflecting advancements in transplant care over time. Additionally, compared to acute liver failure (ALF), etiologies such as primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH), Budd-Chiari syndrome, cryptogenic liver disease, hepatitis B virus (HBV), and primary biliary cholangitis (PBC) were associated with significantly lower mortality risk and improved long-term survival.