Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 18, 2017; 9(8): 427-435
Published online Mar 18, 2017. doi: 10.4254/wjh.v9.i8.427
Factors associated with long-term survival after liver transplantation: A retrospective cohort study
Sven Pischke, Marie C Lege, Moritz von Wulffen, Antonio Galante, Benjamin Otto, Malte H Wehmeyer, Uta Herden, Lutz Fischer, Björn Nashan, Ansgar W Lohse, Martina Sterneck
Sven Pischke, Marie C Lege, Moritz von Wulffen, Antonio Galante, Benjamin Otto, Malte H Wehmeyer, Ansgar W Lohse, Martina Sterneck, Department of Medicine I, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Uta Herden, Lutz Fischer, Björn Nashan, Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Author contributions: Pischke S and Lege MC contributed equally and are both first authors; this work formed part of the thesis of Lege MC; all the authors contributed equally to the study conception and design, performed the data collection, analysis and interpretation, performed the statistical analysis, and drafted and revised the manuscript.
Institutional review board statement: Not needed due to the non-clinical study design.
Informed consent statement: For this retrospective, observational study neither informed consent nor approval of the ethics committee was needed according to the Professional Code of the German Medical Association (article B.III. § 15.1) and to the recommendations of our local ethical committee (Ethikkommission der Ärztekammer Hamburg).
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Data sharing statement: No data were created and no data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Martina Sterneck, Professor, Department of Medicine I, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. sterneck@uke.de
Telephone: +49-68-06920285
Received: August 7, 2016
Peer-review started: August 8, 2016
First decision: September 28, 2016
Revised: December 2, 2016
Accepted: December 13, 2016
Article in press: December 14, 2016
Published online: March 18, 2017
Processing time: 223 Days and 0.1 Hours
Abstract
AIM

To identify predictive factors associated with long-term patient and graft survival (> 15 years) in liver transplant recipients.

METHODS

Medical charts of all de novo adult liver transplant recipients (n = 140) who were transplanted in Hamburg between 1997 and 1999 were retrospectively reviewed. In total, 155 transplantations were identified in this time period (15 re-transplantations). Twenty-six orthotopic liver transplant (OLT) recipients were early lost to follow-up due to moving to other places within 1 year after transplantation. All remaining 114 patients were included in the analysis. The following recipient factors were analysed: Age, sex, underlying liver disease, pre-OLT body mass index (BMI), and levels of alanine aminotransferase (ALT), bilirubin, creatinine and gamma-glutamyltransferase (gamma-GT), as well as warm and cold ischemia times. Furthermore, the following donor factors were assessed: Age, BMI, cold ischemia time and warm ischemia time. All surviving patients were followed until December 2014. We divided patients into groups according to their underlying diagnosis: (1) hepatocellular carcinoma (n = 5, 4%); (2) alcohol toxic liver disease (n = 25, 22.0%); (3) primary sclerosing cholangitis (n = 6, 5%); (4) autoimmune liver diseases (n = 7, 6%); (5) hepatitis C virus cirrhosis (n = 15, 13%); (6) hepatitis B virus cirrhosis (n = 21, 19%); and (7) other (n = 35, 31%). The group “other” included rare diagnoses, such as acute liver failure, unknown liver failure, stenosis and thrombosis of the arteria hepatica, polycystic liver disease, Morbus Osler and Caroli disease.

RESULTS

The majority of patients were male (n = 70, 61%). Age and BMI at the time point of transplantation ranged from 16 years to 69 years (median: 53 years) and from 15 kg/m2 to 33 kg/m2 (median: 24), respectively. Sixty-six OLT recipients (58%) experienced a follow-up of 15 years after transplantation. Recipient’s age (P = 0.009) and BMI (P = 0.029) were identified as risk factors for death by χ2-test. Kaplan-Meier analysis confirmed BMI or age above the median as predictors of decreased long-term survival (P = 0.008 and P = 0.020). Hepatitis B as underlying disease showed a trend for improved long-term survival (P = 0.049, χ2-test, P = 0.055; Kaplan-Meier analysis, Log rank). Pre-transplant bilirubin, creatinine, ALT and gamma-GT levels were not associated with survival in these patients of the pre-era of the model of end stage liver disease.

CONCLUSION

The recipients’ age and BMI were predictors of long-term survival after OLT, as well as hepatitis B as underlying disease. In contrast, donors’ age and BMI were not associated with decreased survival. These findings indicate that recipient factors especially have a high impact on long-term outcome after liver transplantation.

Keywords: Liver transplantation; Age; Body mass index; Long-term survival; Hepatitis B

Core tip: Due to organ shortage and epidemiological developments, the number of older potential orthotopic liver transplant (OLT) recipients increased greatly over the last decades. In order to identify predictors for long-term survival after liver transplantation, we analysed all adult, first OLTs performed at the University Medical Center Hamburg-Eppendorf between 1997 and 1999 and compared these findings with the Eurotransplant database. Our study shows that recipient’s age and body mass index as well as hepatitis B as underlying disease are predictors of long-term survival after OLT.