Long-term follow-up after liver transplantation in patients with hepatic iron overload

Patients with hepatic iron overload who undergo orthotopic liver transplant ation (OLT) have a worse 1-year survival than those who undergo transplanta tion for other indications; the long-term outcome in this population is unk nown. The purpose of this study is to report long-term follow-up after OLT in a cohort of patients with hepatic iron overload. Five liver transplant c enters in the United States reported follow-up data on 37 patients receivin g a first liver transplant who had severe hepatic iron overload in their na tive livers;. Kaplan-Meier 5-year survival among these patients was compare d with survival data from all age-matched liver transplantations reported t o the United Network for Organ Sharing (UNOS) over the same time period (19 87 to 1993). The 5-year survival rate after OLT was 40% in the hepatic iron overload group compared with an overall survival rate of 62% for all patie nt groups from the UNOS registry (P=.0009). Although sepsis was the cause o f 53% of all deaths occurring within the first year after OLT, cardiac comp lications accounted for 50% of the late mortality in patients with hepatic iron overload. In conclusion, longterm survival after OLT is significantly decreased in patients with hepatic iron overload. Infectious and cardiac co mplications are the most common causes of death in these patients. Further studies are needed to define the relationship between hepatic iron overload and mortality and to examine the effect of iron depletion on outcome after OLT in this patient population. Copyright (C) 1999 by the American Associa tion for the Study of Liver Diseases.