Prognostic factors for long-term survival after adult liver transplantation
Prognostic factors for survival ≥ 15 years and life years lost after liver transplantation are largely unknown.
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.
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).
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.
KeywordsPrognostic modeling Utility of transplantation Adult liver transplantation Long-term survival Life years lost
This work was supported by a grant from the German Federal Ministry of Education and Research (reference number 01EO1302).
Soufiane Filali Bouami: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript. Jill Gwiasda: analysis and interpretation of data, critical revision of manuscript. Jan Beneke: study conception and design, analysis, and interpretation of data. Alexander Kaltenborn: analysis and interpretation of data, critical revision of manuscript. Sebastian Liersch: study conception and design, critical revision of manuscript. Eduardo M. Suero: study conception and design, analysis and interpretation of data, critical revision of manuscript. Hans-Friedrich Koch: study conception and design, critical revision of manuscript. Christian Krauth: study conception and design, critical revision of manuscript. Jürgen Klempnauer: critical revision of manuscript. Harald Schrem: study conception and design, analysis and interpretation of data, critical revision of manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Ethics Committee of Hannover Medical School approved of this retrospective study (approval decision number 1683-2013).
Informed consent was obtained from all individual participants included in the study. Patients provided informed consent that their data may be used for scientific purposes at the time of hospital admission which is the general policy of our institution.
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