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Liver transplantation for cryptogenic cirrhosis
M R Charlton1, M Kondo, S K Roberts
1Liver Transplantation Unit, Mayo Clinic, Rochester, MN 55905, USA.
Liver Transplantation and Surgery : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
|July 1, 1997
Summary
Orthotopic liver transplantation (OLT) for cryptogenic cirrhosis shows poorer survival rates compared to other indications. While recurrence of the disease was not observed, unexplained hepatitis developed in 22% of long-term survivors.
Area of Science:
- Hepatology
- Transplantation Immunology
- Gastroenterology
Background:
- Cryptogenic cirrhosis accounts for 7-14% of end-stage liver disease necessitating orthotopic liver transplantation (OLT).
- Limited data exists on the outcomes of OLT specifically for cryptogenic cirrhosis.
- Understanding post-transplant survival and disease recurrence is crucial for patient management.
Purpose of the Study:
- To evaluate patient survival rates following OLT for cryptogenic cirrhosis.
- To determine the incidence of histological recurrence of cryptogenic cirrhosis post-OLT.
- To identify the occurrence of post-transplant hepatitis of unknown origin.
Main Methods:
- Retrospective analysis of 39 OLT recipients for cryptogenic cirrhosis between March 1985 and December 1994.
- Exclusion criteria ensured definitive diagnosis of cryptogenic cirrhosis, ruling out other liver diseases.
- Survival was assessed using actuarial methods; histological recurrence and post-transplant hepatitis were evaluated via protocol liver biopsies in survivors >6 months.
Main Results:
- Cryptogenic cirrhosis recipients were younger but had a higher median Child's-Pugh score pre-transplant compared to non-cryptogenic recipients.
- Actuarial survival rates at 1 and 5 years were significantly lower for cryptogenic recipients (72% and 58%) versus non-cryptogenic (89% and 80%).
- Among 27 long-term survivors, 22% developed unexplained hepatitis; no histological recurrence of cryptogenic cirrhosis was observed.
Conclusions:
- Orthotopic liver transplantation for cryptogenic cirrhosis is associated with significantly poorer survival outcomes.
- Hepatitis of uncertain etiology is a notable complication in a subset of OLT recipients with cryptogenic cirrhosis.
- Current follow-up indicates no evidence of cryptogenic cirrhosis recurrence after OLT.