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 23 April 2018

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Factors affecting long-term outcomes of orthotopic liver transplants

Factors including the recipient, etiology of liver disease, operative variables, and surgical experience influence long-term survival outcomes of liver transplant with benefits greatest in pediatric and nonurgent patients, reports the latest Annals of Surgery.

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Few studies have evaluated long-term outcomes after orthotopic liver transplantation.

Dr Busuttil and colleagues analyzed the experience of nearly 2 decades by the same team in outcomes of orthotopic liver transplantation and factors affecting survival.

The research team conducted a retrospective analysis of 3200 consecutive orthotopic liver transplantation that were performed at a single center between 1984 and 2001.

The researchers reported that of the 2662 recipients, 578 were pediatric, and 659 were urgent patients.

Recipient survival after 5 years in children with biliary atresia was 79%
Annals of Surgery

Overall, the team found that 1-, 5-, 10-, and 15-year patient and graft survival estimates were 81%, 72%, 68%, 64% and 73%, 64%, 59%, 55%, respectively.

The researchers observed that patient survival significantly improved in the second era of transplantation, between 1992 and 2001, versus Era I from 1984 to 1991.

The investigators found that graft survival was better in Era II of transplantation, however, biliary and infectious complications increased in Era II.

When the team considered orthotopic liver transplantation indications, best recipient survival was obtained in children with biliary atresia with 82%, 79%, and 78% at 1, 5, and 10 years, respectively.

The researchers noted that malignant disease in adult patients resulted in the worst outcomes of 68% and 43% at 1 and 5 years, post-orthotopic liver transplantation.

The investigators reported that patients less than 18 years and nonurgent recipients exhibited superior survival when compared with recipients older than 18 years or urgent patients.

The team concluded that of 13 donor and recipient variables, era of orthotopic liver transplantation, recipient age, urgent status, and donor age influenced patient survival.

In addition, donor length of hospital stay, etiology of liver disease, retransplantation, warm and cold ischemia, but not graft type (whole, split, living-donor), significantly impacted patient survival.

Dr Busuttil's team concluded, “Long-term benefits of orthotopic liver transplantation are greatest in pediatric and nonurgent patients.”

“Multiple factors involving the recipient, etiology of liver disease, donor characteristics, operative variables, and surgical experience influence long-term survival outcomes.”

“By balancing and matching these factors with a given recipient, optimum results can be achieved.”

Ann Surg 2005: 241(6): 905
27 May 2005

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