Late mortality after orthotopic liver transplantation

Background: Mortality within the first year after orthotopic liver transpla ntation (OLTx) is usually due to infection or allograft failure. Late compl ications leading to death after OLTx have not been extensively evaluated. T he aim of this study was to determine the incidence of late mortality and t o identify the most common causes and risk factors associated with late mor tality after OLTx. Methods: A total of 479 OLTx were performed in 459 patients (320 males, 139 females; mean age 47 years, range 13 to 69) between September 1991 and Apr il 2000. All patient deaths among liver transplant recipients who survived more than 1 year after transplantation (follow-up mean 3.4 years, median 3, range 1 to 8.6) were reviewed. Results: In all, 122 allografts (24%) were lost in 109 patients during the study period (24%). Seventy-five allografts were lost in 69 patients by 1 y ear (15%), Forty-seven allografts were lost in 40 patients who survived at least 1 year (9.6%). Actuarial survivals at 2 years, 5 years, and 9 years w ere 95%, 85%, and 80%, respectively (based on 100% survival at 1 year). The causes of the late mortality were malignancy (9 patients), disease recurre nce (8), late infection (6), renal failure complications (5), cardiovascula r complications (4), chronic rejection (3), gastrointestinal hemorrhage (2) , medication noncompliance (1), and unknown (2). Conclusions: Malignancy and disease recurrence are the major causes of late mortality among adult OLTx recipients. Pharmacologic immunosuppression is associated with many of the causes of late mortality. Advances in immunosup pression with less toxicity may improve long-term survival after OLTx. (C) 2001 Excerpta Medica, Inc. All rights reserved.