Abstract | OBJECTIVE: The aim of this study was to assess improvements in long-term survival after liver transplant by analyzing outcomes in transplant recipients who survived beyond 1 year. SUMMARY OF BACKGROUND DATA: Gains in short-term survival following liver transplantation have been gratifying. One-year survival in 1986 was 66% improved to over 92% in 2015. However, little is known about why long-term has not seen similar success. METHODS: We analyzed 111,568 recipients from 1987 to 2016 using the Kaplan-Meier method for time-to-event analysis and multivariable Cox regression. RESULTS: There were no significant gains in unadjusted long-term outcomes among 1-year survivors over the past 30 years. Only the time periods of 1987 to 1990 [hazard ratio (HR) 1.35, confidence interval CI) 1.28-1.42] and 1991 to 1995 (HR 1.17, CI 1.13-1.21) had a minor increase in risk compared with the period 2011 to 2016. Cause of death analysis suggests malignancy after transplantation is a growing problem and preventing recurrent hepatitis C with direct-acting antivirals (DDAs) may only have a limited impact. Furthermore, rejection leading to graft failure and death had a rare occurrence (1.7% of long-term deaths) especially when compared with the sequelae of long-term immunosuppression: malignancy (16.4%), nonrejection graft failure (9.8%), and infection (10.5%) (P < 0.001). CONCLUSION: In stark contrast to short-term survival, there have been no appreciable improvements in long-term survival following liver transplantation among 1-year survivors. Long-term sequelae of immunosuppression, including malignancy and infection, are the most common causes of death. This study highlights the need for better long-term immunosuppression management.
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Authors | Abbas Rana, Ruth L Ackah, Gwilym J Webb, Karim J Halazun, John M Vierling, Hao Liu, Meng-Fen Wu, Dor Yoeli, Michael Kueht, Ayse L Mindikoglu, Norman L Sussman, Nhu T Galván, Ronald T Cotton, Christine A O'Mahony, John A Goss |
Journal | Annals of surgery
(Ann Surg)
Vol. 269
Issue 1
Pg. 20-27
(01 2019)
ISSN: 1528-1140 [Electronic] United States |
PMID | 29303806
(Publication Type: Journal Article, Multicenter Study)
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Topics |
- Adult
- Aged
- Cause of Death
(trends)
- Female
- Follow-Up Studies
- Graft Rejection
(epidemiology)
- Graft Survival
- Humans
- Liver Transplantation
(mortality)
- Male
- Middle Aged
- Prognosis
- Retrospective Studies
- Risk Factors
- Time Factors
- Transplant Recipients
- United Kingdom
(epidemiology)
- Young Adult
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