Disease recurrence after liver transplantation in Western Australia.
OBJECTIVE
Orthotopic liver transplantation (OLT) is now the accepted therapy for end-stage chronic liver disease. Long-term survival is now expected in the majority of patients and, consequently, disease recurrence has emerged as a major concern. Our aim was to document the rate of disease recurrence after liver transplantation for conditions other than hepatitis C, in patients followed up by the Western Australian Liver Transplant Service (WALTS).


METHODS
The case notes of all post-OLT patients followed up by WALTS were reviewed. Patients were excluded if survival was less than 3 months post-OLT; OLT was performed for hepatitis C alone or follow up was unavailable. Detection and definition of disease recurrence depended on pretransplant diagnosis, and were based on patient interview, biochemical, immunological and serological tests. Radiological and histological confirmation were obtained where clinically indicated.


RESULTS
Eighty-seven patients were identified (89 OLTs performed). The overall rate of recurrence was 10%. Recurrence rates by disease were: primary sclerosing cholangitis (17%), primary biliary cirrhosis (12%), autoimmune hepatitis (17%), hepatitis B (40%) and alcoholic liver disease (4%). Alcohol use relapse after transplantation occurred in 25%. The overall survival post-OLT was 87%, with a mean follow up of 53 months. Survival in patients with recurrent disease was 89%.


CONCLUSIONS
Disease recurrence after OLT does occur, but overall, it is relatively uncommon. Recurrence rates vary significantly and depend, in part, on indication for OLT. With medium-term follow up, recurrent disease does not have an effect on mortality.
Yusoff
Ian F
IF
The Western Australian Liver Transplant Service, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia. ian.yusoff@health.wa.gov.au
House
Anthony K
AK
De Boer
W Bastiaan
WB
Ferguson
John
J
Garas
George
G
Heath
Dugal
D
Mitchell
Andrew
A
Jeffrey
Gary p
Gp
D000293:Adolescent; D000328:Adult; D015209:Cholangitis, Sclerosing / Q000401:mortality / Q000601:surgery; D005260:Female; D006509:Hepatitis B / Q000401:mortality / Q000601:surgery; D019693:Hepatitis, Autoimmune / Q000401:mortality / Q000601:surgery; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000401:mortality / Q000601:surgery; D008107:Liver Diseases / Q000401:mortality / Q000601:surgery*; D008108:Liver Diseases, Alcoholic / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015996:Survival Rate