Soufiane Filali Bouami1, Jill Gwiasda2, Jan Beneke2, Alexander Kaltenborn2, Sebastian Liersch3,4, Eduardo M Suero4, Hans-Friedrich Koch2, Christian Krauth3,4, Jürgen Klempnauer3, Harald Schrem2,3. 1. Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. FilaliBouami.Soufiane@mh-hannover.de. 2. Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. 3. General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany. 4. Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany.
Abstract
PURPOSE: Prognostic factors for survival ≥ 15 years and life years lost after liver transplantation are largely unknown. METHODS: One thousand six hundred thirty primary adult liver transplants between 1983 and 2014 were analyzed. Risk factors for survival were identified with multivariable Cox regression and subsequently tested for their relevance as prognostic factors for observed 15-year survival using multivariable logistic regression and c statistics. The difference of life expectancy between a matched national reference population and survival in patients with post-transplant survival ≥ 15 years was calculated. RESULTS: Survival of ≥ 15 years was observed in 361 patients (22%). Sixty-nine adults died after more than 15 years losing a median of 15 years of life expectancy. One of those patients lived longer while 292 patients still have the chance to survive longer than their normal life expectancy. The indication primary sclerosing cholangitis (PSC) and later eras of transplantation were identified as significant independent protective factors while recipient age > 36.8 years, graft loss due to initial non-function or thrombosis, the indications hepatocellular carcinoma (HCC), hepatitis-C-virus-related cirrhosis (HCV-cirrhosis) and all other indications, donor age > 53 years, the number of surgical complications, and operative durations > 4.5 h were identified as significant independent risk factors limiting survival. All of these factors except the duration of operation had also a significant independent influence on observed 15-year survival (AUROC = 0.739). CONCLUSIONS: Recipients can exceptionally live longer than their normal life expectancy. Older recipients and patients with the indications HCC, HCV-cirrhosis, or other indications except PSC, should be transplanted with younger donor organs.
PURPOSE: Prognostic factors for survival ≥ 15 years and life years lost after liver transplantation are largely unknown. METHODS: One thousand six hundred thirty primary adult liver transplants between 1983 and 2014 were analyzed. Risk factors for survival were identified with multivariable Cox regression and subsequently tested for their relevance as prognostic factors for observed 15-year survival using multivariable logistic regression and c statistics. The difference of life expectancy between a matched national reference population and survival in patients with post-transplant survival ≥ 15 years was calculated. RESULTS: Survival of ≥ 15 years was observed in 361 patients (22%). Sixty-nine adults died after more than 15 years losing a median of 15 years of life expectancy. One of those patients lived longer while 292 patients still have the chance to survive longer than their normal life expectancy. The indication primary sclerosing cholangitis (PSC) and later eras of transplantation were identified as significant independent protective factors while recipient age > 36.8 years, graft loss due to initial non-function or thrombosis, the indications hepatocellular carcinoma (HCC), hepatitis-C-virus-related cirrhosis (HCV-cirrhosis) and all other indications, donor age > 53 years, the number of surgical complications, and operative durations > 4.5 h were identified as significant independent risk factors limiting survival. All of these factors except the duration of operation had also a significant independent influence on observed 15-year survival (AUROC = 0.739). CONCLUSIONS: Recipients can exceptionally live longer than their normal life expectancy. Older recipients and patients with the indications HCC, HCV-cirrhosis, or other indications except PSC, should be transplanted with younger donor organs.
Entities:
Keywords:
Adult liver transplantation; Life years lost; Long-term survival; Prognostic modeling; Utility of transplantation
Authors: René Adam; Vincent Karam; Valérie Delvart; John O'Grady; Darius Mirza; Jurgen Klempnauer; Denis Castaing; Peter Neuhaus; Neville Jamieson; Mauro Salizzoni; Stephen Pollard; Jan Lerut; Andreas Paul; Juan Carlos Garcia-Valdecasas; Fernando San Juan Rodríguez; Andrew Burroughs Journal: J Hepatol Date: 2012-05-16 Impact factor: 25.083
Authors: A Jain; J Reyes; R Kashyap; S F Dodson; A J Demetris; K Ruppert; K Abu-Elmagd; W Marsh; J Madariaga; G Mazariegos; D Geller; C A Bonham; T Gayowski; T Cacciarelli; P Fontes; T E Starzl; J J Fung Journal: Ann Surg Date: 2000-10 Impact factor: 12.969
Authors: Harald Schrem; Moritz Focken; Bridget Gunson; Benedikt Reichert; Darius Mirza; Hans-Heinrich Kreipe; Desley Neil; Alexander Kaltenborn; Alon Goldis; Christian Krauth; Keith Roberts; Thomas Becker; Jürgen Klempnauer; James Neuberger Journal: Liver Transpl Date: 2016-06 Impact factor: 5.799
Authors: Valentín Cuervas-Mons; Gloria de la Rosa; Fernando Pardo; Fernando San Juan; Andrés Valdivieso Journal: Med Clin (Barc) Date: 2014-11-13 Impact factor: 1.725
Authors: Fredrik Åberg; Mika Gissler; Tom H Karlsen; Bo-Göran Ericzon; Aksel Foss; Allan Rasmussen; William Bennet; Michael Olausson; Pål-Dag Line; Arno Nordin; Annika Bergquist; Kirsten Muri Boberg; Maria Castedal; Christian Ross Pedersen; Helena Isoniemi Journal: Hepatology Date: 2015-01-05 Impact factor: 17.425