OBJECTIVE: To evaluate the long-term survival outcomes of a large cohort of liver transplant recipients and to identify static and changing factors that influenced these outcomes over time. SUMMARY BACKGROUND DATA: Liver transplantation has been accepted as a therapeutic option for patients with end-stage liver disease since 1983, with continual improvements in patient survival as a result of advances in immunosuppression and medical management, technical achievements, and improvements in procurement and preservation. Although many reports, including registry data, have delineated short-term factors that influence survival, few reports have examined factors that affect long-term survival after liver transplantation. METHODS: Four thousand consecutive patients who underwent liver transplantation between February 1981 and April 1998 were included in this analysis and were followed up to March 2000. The effect of donor and recipient age at the time of transplantation, recipient gender, diagnosis, and year of transplantation were compared. Rates of retransplantation, causes of retransplantation, and cause of death were also examined. RESULTS: The overall patient survival for the entire cohort was 59%; the actuarial 18-year survival was 48%. Patient survival was significantly better in children, in female recipients, and in patients who received transplants after 1990. The rates of retransplantation for acute or chronic rejection were significantly lower with tacrolimus-based immunosuppression. The risk of graft failure and death was relatively stable after the first year, with recurrence of disease, malignancies, and age-related complications being the major factors for loss. CONCLUSION: Significantly improved patient and graft survival has been observed over time, and graft loss from acute or chronic rejection has emerged as a rarity. Age-related and disease-related causes of graft loss represent the greatest threat to long-term survival.
OBJECTIVE: To evaluate the long-term survival outcomes of a large cohort of liver transplant recipients and to identify static and changing factors that influenced these outcomes over time. SUMMARY BACKGROUND DATA: Liver transplantation has been accepted as a therapeutic option for patients with end-stage liver disease since 1983, with continual improvements in patient survival as a result of advances in immunosuppression and medical management, technical achievements, and improvements in procurement and preservation. Although many reports, including registry data, have delineated short-term factors that influence survival, few reports have examined factors that affect long-term survival after liver transplantation. METHODS: Four thousand consecutive patients who underwent liver transplantation between February 1981 and April 1998 were included in this analysis and were followed up to March 2000. The effect of donor and recipient age at the time of transplantation, recipient gender, diagnosis, and year of transplantation were compared. Rates of retransplantation, causes of retransplantation, and cause of death were also examined. RESULTS: The overall patient survival for the entire cohort was 59%; the actuarial 18-year survival was 48%. Patient survival was significantly better in children, in female recipients, and in patients who received transplants after 1990. The rates of retransplantation for acute or chronic rejection were significantly lower with tacrolimus-based immunosuppression. The risk of graft failure and death was relatively stable after the first year, with recurrence of disease, malignancies, and age-related complications being the major factors for loss. CONCLUSION: Significantly improved patient and graft survival has been observed over time, and graft loss from acute or chronic rejection has emerged as a rarity. Age-related and disease-related causes of graft loss represent the greatest threat to long-term survival.
Authors: F D MOORE; H B WHEELE; H V DEMISSIANOS; L L SMITH; O BALANKURA; K ABEL; J B GREENBERG; G J DAMMIN Journal: Ann Surg Date: 1960-09 Impact factor: 12.969
Authors: J J Fung; M Eliasziw; S Todo; A Jain; A J Demetris; J P McMichael; T E Starzl; P Meier; A Donner Journal: J Am Coll Surg Date: 1996-08 Impact factor: 6.113
Authors: R D Gordon; S Todo; A G Tzakis; J J Fung; A Stieber; S M Staschak; S Iwatsuki; T E Starzl Journal: Transplant Proc Date: 1991-02 Impact factor: 1.066
Authors: S Asfar; P Metrakos; J Fryer; D Verran; C Ghent; D Grant; M Bloch; P Burns; W Wall Journal: Transplantation Date: 1996-05-15 Impact factor: 4.939
Authors: J Laine; H Jalanko; U M Saarinen-Pihkala; K Höckerstedt; M Leijala; C Holmberg; M Heikinheimo Journal: Transplantation Date: 1999-05-27 Impact factor: 4.939
Authors: M Facciuto; D Heidt; J Guarrera; C A Bodian; C M Miller; S Emre; S R Guy; T M Fishbein; M E Schwartz; P A Sheiner Journal: Liver Transpl Date: 2000-03 Impact factor: 5.799
Authors: O Abbasoglu; M F Levy; B B Brkic; G Testa; D R Jeyarajah; R M Goldstein; B S Husberg; T A Gonwa; G B Klintmalm Journal: Transplantation Date: 1997-12-27 Impact factor: 4.939
Authors: E J Gane; B C Portmann; N V Naoumov; H M Smith; J A Underhill; P T Donaldson; G Maertens; R Williams Journal: N Engl J Med Date: 1996-03-28 Impact factor: 91.245
Authors: I R Marino; H R Doyle; L Aldrighetti; C Doria; J McMichael; T Gayowski; J J Fung; A G Tzakis; T E Starzl Journal: Hepatology Date: 1995-12 Impact factor: 17.425
Authors: R Kashyap; A Jain; J Reyes; A J Demetris; K A Elmagd; S F Dodson; W Marsh; V Madariaga; G Mazariegos; D Geller; C A Bonham; T Cacciarelli; P Fontes; T E Starzl; J J Fung Journal: Transplant Proc Date: 2001 Feb-Mar Impact factor: 1.066
Authors: R Kashyap; A Jain; J Reyes; A J Demetris; K A Elmagd; S F Dodson; W Marsh; V Madariaga; G Mazariegos; D Geller; C A Bonham; T Cacciarelli; P Fontes; T E Starzl; J J Fung Journal: Transplant Proc Date: 2001 Feb-Mar Impact factor: 1.066
Authors: Christian Koenecke; Moritz Kleine; Harald Schrem; Utz Krug; Bjoern Nashan; Michael Neipp; Arnold Ganser; Bernd Hertenstein; Juergen Klempnauer Journal: Int J Hematol Date: 2006-04 Impact factor: 2.490
Authors: John E Scarborough; Ricardo Pietrobon; Carlos E Marroquin; Janet E Tuttle-Newhall; Paul C Kuo; Bradley H Collins; Dev M Desai; Theodore N Pappas Journal: J Gastrointest Surg Date: 2007-01 Impact factor: 3.452