Long-term survival after liver transplantation

Background: Liver transplantation (LT) remains a high-risk operation, espec ially during the first months after LT when technical complications and pre existing illness exert their influence on survival. However, there are late deaths. The authors have reviewed their experience to identify factors imp acting on long-term survival. Methods: A total of 150 patients who had undergone liver transplantation ov er an 11-year period were reviewed. Thirty-three patients died after LT (22 %). Of these, 18 of 33 (55%) died in the first 3 postoperative months. One hundred thirty-two patients survived beyond 3 months, and 15 patients (11%) suffered late deaths. This review concentrates on the latter group. Results: The primary cause of death was sepsis in ii of 15 (73%). In two, s epsis complicated retransplantation in chronically debilitated patients. Tw o additional patients had late-presenting postoperative complications (bile leak or abscess, intestinal obstruction with perforation). In two cases, p neumocystis carinii pneumonia occurred; noncompliance or unplanned disconti nuation of prophylaxis was directly responsible. Multiple organ system fail ure from presumed immunoincompetence developed in four patients; one had un dergone bone marrow transplantation for aplastic anemia (AA) after fulminan t hepatic failure (FHF). Lymphoproliferative disease (LPD) was the cause of death in 3 of 15 cases (20%). In only three cases was the cause of death r elated to the patient's primary disease (chronic hepatitis, Alper's syndrom e or seizures, and AA with FHF). Pretransplant diagnosis, and UNOS status a t the time of LT did not influence the long-term survival. Conclusions: Long-term survival in patients who have undergone LT was compr omised by immunosuppressive complications and sepsis. Early mortality facto rs, such as UNOS status, age at LT, primary diagnosis, and technical compli cations do not predict late deaths. In children who adhere to their medical regimen and have good initial allograft function, late postoperative infec tion, especially with Ebstein-Barr virus, accounts for most of the late mor tality. Improved and decreased immunosuppression may further improve these long-term results. Copyright (C) 1999 by W.B. Saunders Company.