Factors associated with long-term survival after liver transplantation:A retrospective cohort study
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 revie...
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Published in | World journal of hepatology Vol. 9; no. 8; pp. 427 - 435 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Baishideng Publishing Group Inc
18.03.2017
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Subjects | |
Online Access | Get full text |
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Summary: | 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 followup 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 gammaglutamyltransferase(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) hepatocellularcarcinoma(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/m~2 to 33 kg/m~2(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 χ~2-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,χ~2-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 longterm 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. |
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Bibliography: | Sven Pischke;Marie C Lege;Moritz von Wulffen;Antonio Galante;Benjamin Otto;Malte H Wehmeyer;Uta Herden;Lutz Fischer;Bj?rn Nashan;Ansgar W Lohse;Martina Sterneck;Department of Medicine I,University Medical Center Hamburg-Eppendorf;Department of Hepatobiliary and Transplant Surgery,University Medical Center Hamburg-Eppendorf ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Correspondence to: Dr. Martina Sterneck, Professor, Department of Medicine I, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. sterneck@uke.de Author contributions: Pischke S and Lege MC contributed equally and are both first authors; this work formed part of the thesis of Lege MC; all the authors contributed equally to the study conception and design, performed the data collection, analysis and interpretation, performed the statistical analysis, and drafted and revised the manuscript. Telephone: +49-68-06920285 |
ISSN: | 1948-5182 1948-5182 |
DOI: | 10.4254/wjh.v9.i8.427 |