Factors associated with long-term survival after liver transplantation:A retrospective cohort study

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 followup 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 gammaglutamyltransferase(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) hepatocellularcarcinoma(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/m^2 to 33 kg/m^2(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 χ~2-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,χ~2-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 longterm 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.

Impact of donor-specific antibodies on long-term graft survival with pediatric liver transplantation

BACKGROUND In a previous paper,we reported a high prevalence of donor-specific antibody(DSA)in pediatric patients with chronic rejection and expressed the need for confirmation of these findings in a larger cohort.AIM To clarify the importance of DSAs on long-term graft survival in a larger cohort of pediatric patients.METHODS We performed a retrospective analysis of 123 pediatric liver transplantation(LT)recipients who participated in yearly follow-ups including Luminex testing for DSA at our center.The cohort was split into two groups according to the DSA status(DSA-positive n=54,DSA-negative n=69).Groups were compared with regard to liver function,biopsy findings,graft survival,need for re-LT and immunosuppressive medication.RESULTS DSA-positive pediatric patients showed a higher prevalence of chronic rejection(P=0.01),fibrosis(P<0.001)and re-transplantation(P=0.018)than DSA-negative patients.Class II DSAs particularly influenced graft survival.Alleles DQ2,DQ7,DQ8 and DQ9 might serve as indicators for the risk of chronic rejection and/or allograft fibrosis.Mean fluorescence intensity levels and DSA number did not impact graft survival.Previous episodes of chronic rejection might lead to DSA development.CONCLUSION DSA prevalence significantly affected long-term liver allograft performance and liver allograft survival in our cohort of pediatric LT.Screening for class II DSAs in combination with assessment of protocol liver biopsies for chronic antibodymediated rejection improved early identification of patients at risk of graft loss.