Long-term survival after liver transplantation in 4,000 consecutive patients at a single center

Objective To evaluate the long-term survival outcomes of a large cohort of liver transplant recipients and to identify static and changing factors tha t influenced these outcomes over time. Summary Background Data Liver transplantation has been accepted as a therap eutic option for patients with end-stage liver disease since 1983, with con tinual improvements in patient survival as a result of advances in immunosu ppression and medical management, technical achievements, and improvements in procurement and preservation. Although many reports, including registry data, have delineated short-term factors that influence survival, few repor ts have examined factors that affect long-term survival after liver transpl antation. Methods Four thousand consecutive patients who underwent liver transplantat ion between February 1981 and April 1998 were included in this analysis and were followed up to March 2000. The effect of donor and recipient age at t he time of transplantation, recipient gender, diagnosis, and year of transp lantation were compared. Rates of retransplantation, causes of retransplant ation, and cause of death were also examined. Results The overall patient survival for the entire cohort was 59%; the act uarial 18-year survival was 48%. Patient survival was significantly better in children, in female recipients, and in patients who received transplants after 1990. The rates of retransplantation for acute or chronic rejection were significantly lower with tacrolimus-based immunosuppression. The risk of graft failure and death was relatively stable after the first year, with recurrence of disease, malignancies, and age-related complications being t he major factors for loss. Conclusion Significantly improved patient and graft survival has been obser ved over time, and graft loss from acute or chronic rejection has emerged a s a rarity. Age-related and disease-related causes of graft loss represent the greatest threat to long-term survival.