Long-term medical complications in patients surviving >= 5 years after liver transplant

Background Short-term outcomes of liver transplantation are well reported. Little is known, however, about long-term results in liver recipients survi ving greater than or equal to 5 years. We sought to analyze long-term compl ications in liver recipients surviving greater than or equal to 5 years aft er transplant, to assess their medical condition and to compare findings to the general population. Methods. We analyzed the chart and database records of all patients (n=139) who underwent liver transplantation at a major transplant center before Ja nuary 1, 1991, Outcome measures included the presence of diabetes, hyperten sion, heart, renal or neurological disease, osteoporosis, incidence of de n ovo malignancy or fracture, or other pathology, body mass index, serum chol esterol and glucose, liver function, blood pressure, frequency of laborator y and clinic follow-up, current pharmacological regimen, and late rejection episodes. Results. Ninety-six patients (70%) survived greater than or equal to 5 year s. Compared to numbers expected based on U.S. population rates, transplant recipients had significantly higher overall prevalences of hypertension (st andardized prevalence ratio [SPR]=3.07, 95% confidence interval [CI], 2.35- 3.93) and diabetes (SPR=5.99, 95% CI, 4.15-8.38), and higher incidences of de novo malig-. nancy (standardized incidence ratio [SIR]=3.94, 95% CI, 2.0 9-6.73), non-Hodgkin's lymphoma (SIR=28.56, 95% CI, 7.68-73.11), non; melan oma skin cancer (estimated SIR greater than or equal to 3.16) and fractures in women (SIR=2.05, 95% CI, 1.12-3.43), Forty-one of 87 (47.1%) patients w ere obese, and 23 patients (27.4%) had elevated serum cholesterol levels (g reater than or equal to 240 mg/dl, 6.22 mmol/L), compared to 33% and 19.5% of U.S. adults, respectively. Prevalences of heart or peptic ulcer disease were not significantly higher. Conclusions. Liver transplantation is being performed with excellent B-year survival. Significant comorbidities exist, however, which appear to be rel ated to long-term immunosuppression.