Analysis of long-term outcomes of 3200 liver transplantations over two decades: a single-center experience.
OBJECTIVE
Few studies have evaluated long-term outcomes after orthotopic liver transplantation (OLT). This work analyzes the experience of nearly 2 decades by the same team in a single center. Outcomes of OLT and factors affecting survival were analyzed.


METHODS
Retrospective analysis of 3200 consecutive OLTs that were performed at our institution, between February 1984 and December 31, 2001.


RESULTS
Of 2662 recipients, 578 (21.7%) and 659 (24.7%) were pediatric and urgent patients, respectively. Overall 1-, 5-, 10-, and 15-year patient and graft survival estimates were 81%, 72%, 68%, 64% and 73%, 64%, 59%, 55%, respectively. Patient survival significantly improved in the second (1992-2001) versus the era I (1984-1991) of transplantation (P < 0.001). Similarly, graft survival was better in the era II of transplantation (P < 0.02). However, biliary and infectious complications increased in era II. When OLT indications were considered, best recipient survival was obtained in children with biliary atresia (82%, 79%, and 78% at 1, 5, and 10 years, respectively), while malignant disease in adult patients resulted in the worst outcomes of 68% and 43% at 1 and 5 years, post-OLT. Further, patients <18 years and nonurgent recipients exhibited superior survival when compared with recipients >18 years (P < 0.001) or urgent patients (P < 0.001). Of 13 donor and recipient variables, era of OLT, recipient age, urgent status, donor age, 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.


CONCLUSIONS
Long-term benefits of OLT 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.
Busuttil
Ronald W
RW
Dumont-UCLA Liver Transplant Center, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. rghobria@mednet.ucla.edu
Farmer
Douglas G
DG
Yersiz
Hasan
H
Hiatt
Jonathan R
JR
McDiarmid
Sue V
SV
Goldstein
Leonard I
LI
Saab
Sammy
S
Han
Steven
S
Durazo
Francisco
F
Weaver
Michael
M
Cao
Carlos
C
Chen
Tony
T
Lipshutz
Gerald S
GS
Holt
Curtis
C
Gordon
Sherilyn
S
Gornbein
Jeffery
J
Amersi
Farin
F
Ghobrial
Rafik M
RM
D000293:Adolescent; D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000401:mortality / Q000601:surgery; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome