Background. We undertook this study to understand the causes of late g
raft loss and long-term outcome in orthotopic liver transplantation (O
LT) recipients, Methods. Prospectively collected data of 1174 consecut
ive OLT in 1045 adult patients who received liver grafts between April
1985 and August 1995 were reviewed. The causes of graft loss, pretran
splant patient characteristics, and posttransplant events were analyze
d in patients who survived at least 1 year after OLT, in an attempt to
establish a link between these factors and graft loss, Results. One h
undred fifty-nine (17.9%) grafts were lost after the first year. Of th
ese, 132 grafts were lost by death and 27 by retransplantation. Recipi
ents who survived the first year (n=884) had 5- and 10-year survivals
of 81.4% and 67.2%, respectively, Death with a functioning graft occur
red in 97 (61%) patients. The main causes of late graft loss were recu
rrent disease (n=48), cardiovascular and cerebral vascular accidents (
n=28), infections (n=24), and chronic rejection (n=15). Pretransplant
heart disease and diabetes were found to be significant risk factors f
or late graft loss due to cardiovascular diseases and cerebral vascula
r accidents, Conclusions. Survival of OLT patients who live beyond the
first posttransplant year is excellent. Some patient characteristics
may be associated with late graft loss, Compared with previous reports
, this study shows an increased incidence of late graft loss secondary
to recurrent diseases, de novo malignancies, cardiovascular diseases,
and cerebral vascular accidents. Chronic rejection seems to be a less
frequent cause of late graft loss, The prevention of recurrent diseas
e and better immunosuppression may further improve these results.