Why do patients die after a liver transplantation?

• Published in: Clinical transplantation 2017-03, Vol.31 (3), p.np-n/a
• Main Authors: Daniel, Kim E., Eickhoff, Jens, Lucey, Michael R.
• Format: Article
• Language: English
• Subjects: Cause of Death; Female; Follow-Up Studies; Graft Rejection - etiology; Graft Rejection - mortality; Graft Survival; Humans; infection; liver transplantation; Liver Transplantation - adverse effects; Liver Transplantation - mortality; long‐term survivors; Male; malignancy; Middle Aged; mortality; Postoperative Complications - mortality; Prognosis; Registries; Retrospective Studies; Risk Factors
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.12906

Background As more patients achieve long‐term survival, it has become important to understand mortality in liver transplantation (LT) recipients. Methods We conducted retrospective reviews of long‐term outcome in two adult LT cohorts: 85 031 in the United Network for Organ Sharing (UNOS) database and 1458 transplanted at the University of Wisconsin (UW). Results During median follow‐up of 3.2 years (UNOS) and 6.6 years (UW), 35.1% of UNOS patients and 44.2% of UW patients died; 43.1% of all UNOS deaths occurred in year 1 compared to 25.1% in the UW cohort. Deaths due to infection (other than viral hepatitis) or cardiovascular (CV) causes were most frequent in year 1 in both cohorts and then persisted at lower rates. In contrast, death from malignancy increased after year 1 to peak in years 1‐5. Deaths due to rejection, hepatitis, or graft failure were infrequent. In the UW cohort, de novo malignancy was more common than recurrent tumor and correlated with smoking history. Conclusions A coordinated holistic approach that focuses on limiting immunosuppression, infection, risky behaviors, and CV risks, while screening for cancer, is needed to extend the healthy lives of LT recipients.