Professor Rene Adam and colleagues around Europe analyzed information listed on the European Liver Transplant Registry. They reviewed 22,089 patients from 102 centers in 18 different countries, who had been transplanted between 1988 and 1997.
22,089 patients from 102 centers in 18 European countries transplanted 1988-97.
Professor Adam found that the overall 5-year and 8-year survival rates after transplantation were 66% and 61%, respectively. 65% of deaths occurred within 6 months after transplantation.
The main mortality risk factors were identified as retransplantation, transplantation for cancer, acute liver failure, and a center annual workload of less than either 20 split-liver grafts or 25 whole-organ transplants.
Mortality risk factors:
acute liver failure
<20 split-liver grafts p.a.
<25 whole-organ transplants p.a.
The 5-year survival rate rose to 78% for patients with none of the main risk factors.
Cancer and retransplantation caused the most significant fall in survival rates.
Only 40% of cancer patients survived for 5 years after transplantation, compared with 69% of non-cancer patients. The 5-year survival rate for patients who underwent retransplantation was 44%, compared with 69% for patients who had only one graft.
Worryingly, centers which carried out less than 25 transplants per year were shown to have only a 61% 5-year survival rate, compared with a 70% survival rate for those completing over 90 transplants each year.
"Our results encourage the concentration of liver transplantation in a limited number of centers."
Professor Rene Adam
More promisingly, the study shows that survival rates have increased during the last 10 years: of patients who underwent transplantation in 1997, 83% were still alive one year later.