Promising liver transplant outcomes at 20 years

Image: PD 

1. Liver transplant recipients have good long-term outcomes, with 52.5% of patients alive after 20 years. 

2. Most deaths are attributable to complications of long-term immunosuppression such as infection, malignancy, and cardiovascular disease. 

Evidence Rating Level: 2 (Good) 

Study Rundown: While short-term survival for liver transplantation (LT) has improved dramatically due to increasing technical expertise and enhanced immunosuppression, long-term results have been slower to follow. This single-center longitudinal study evaluated factors affecting 20-year LT outcomes, finding highly promising results with 52.5% of patients alive after 20 years and elderly LT recipients surviving at similar rates to the normal population. Many deaths were likely due to prolonged immunosuppression, calling for its continued optimization. Additionally, the high incidence of cardiovascular disease and lung cancer in particular suggest that more care must be taken in reducing risk factors in this population. Organ allocation policy and immune suppression have changed dramatically over the past 20 years, making generalization of these results to the current group of transplant patients difficult..

Click to read the study in Am J Transplantation

Relevant Reading: Evolution of causes and risk factors for mortality post-liver transplant: results of the NIDDK long-term follow-up study

In-Depth [retrospective cohort study]: 313 consecutive patients from a single center were prospectively observed over 20 years for overweight, hypertension, diabetes, hyperlipidemia, and moderately or severely impaired renal function. Excluding patients who died within 6 months after transplant, patient survival at 1, 10, and 20 years was 97.6%, 80.8%, and 58.8%. Gender, age, retransplantation, etiology, and impaired renal function at 6 months were found to significantly impact survival. Patients with biliary malignancies and HCC showed significantly worse survival rates (24.7% at 20 years), while those with autoimmune or cholestatic disease had better survival (67.5%). Interestingly, prolonged cold ischemia time did not significantly impact patient or graft survival. The most common causes of death were recurrent disease (21.3%), infection (20.6%), de novo malignancy (19.9%), and cardiovascular disease (14.9%).  Lung cancer in particular accounted for 42.9% of lethal de novo malignancies.

By Mariya Samoylova and Chaz Carrier

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