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.
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.
Authors: Sulemon Chaudhry; Yojiro Kato; Joshua Weiner; Paula Alonso-Guallart; Sam Baker; David C Woodland; Jay H Lefkowitch; Raimon Duran-Struuck; Hugo P Sondermeijer; Jonah Zitsman; Mallory L Sears; Anette Wu; Brian Karolewski; Philipp J Houck; Mercedes Martinez; Tomoaki Kato; Megan Sykes; Adam D Griesemer Journal: Transplantation Date: 2020-04-06 Impact factor: 4.939
Authors: Nicole Bernardi; Marcio F Chedid; Tomaz J M Grezzana-Filho; Aljamir D Chedid; Marcelo A Pinto; Ian Leipnitz; João E Prediger; Carolina Prediger; Ariane N Backes; Thais O Hammes; Lea T Guerra; Alexandre de Araujo; Mario R Alvares-da-Silva; Cleber R P Kruel Journal: Dig Dis Sci Date: 2019-01-14 Impact factor: 3.199
Authors: Sulemon Chaudhry; Yojiro Kato; Joshua Weiner; Paula Alonso-Guallart; Sam Baker; David C Woodland; Jay H Lefkowitch; Raimon Duran-Struuck; Hugo P Sondermeijer; Jonah Zitsman; Mallory L Sears; Anette Wu; Brian Karolewski; Philipp J Houck; Mercedes Martinez; Tomoaki Kato; Megan Sykes; Adam D Griesemer Journal: Transplantation Date: 2020-08 Impact factor: 5.385