CAUSES OF LATE GRAFT LOSS AFTER LIVER-TRANSPLANTATION

The causes of graft loss in liver transplant recipients with a graft f unctioning for more than 1 year post-transplant were analyzed. Of 500 liver transplants in 434 patients, 362 grafts were functioning for mor e than 1 year. After 1 year, 42 grafts were later lost (11.6%). Thirty -three grafts were lost by death and 9 retransplants were done with 8 patients. Of the grafts lost by death, 12 had no evidence of dysfuncti on. The actuarial 2- and 5-year graft survival in liver transplantatio n recipients with functioning grafts for more than 1 year was 91 and 8 3%, respectively. The graft loss rate was 3.4 times higher during the 2nd year post-transplant than during 2-5 years post-transplant. The mo st common causes of graft loss were chronic rejection (26.2%), recurre nt hepatitis (23.8%), arterial thrombosis/stenosis (11.9%) and recurre nt malignancy (9.5%). No graft was lost from acute rejection. There wa s no difference in timing of the graft lost between the different caus es. The pretransplant diagnosis of hepatitis B, chronic rejection, and malignancy was associated with the highest frequency of late graft lo st. In conclusion, long-term graft survival is good after liver transp lantation in patients with a functioning graft for more than 1 year. T he main causes of graft loss were chronic rejection and recurrent hepa titis. Prevention and treatment for these conditions may further impro ve the results after liver transplantation.