title: A disease-based comparison of liver transplantation outcomes.
abstract: An increasing demand for transplant donor organs has made optimal allocation of resources a priority. Our objective was to evaluate outcomes for orthotopic liver transplantation (OLT) performed in the United States. A query of the United Network for Organ Sharing registry between 1988 and 2007 was performed for patients who underwent OLT for all etiologies. Patients were stratified by pathology necessitating OLT and clinical and pathologic factors were compared. Multivariate Cox-regression analysis was used to assess the association of pathology with survival. Of 61,823 patients, 33 per cent (n = 20,305) of OLTs were secondary to hepatitis C virus, 21 per cent autoimmune disease, 17 per cent alcohol-induced injury, 11 per cent cryptogenic cirrhosis, 8 per cent hepatocellular carcinoma (HCC), 6 per cent hepatitis B virus, and 4 per cent metabolic disease. Patients with autoimmune disease and HCC demonstrated the best and worst survival, respectively, after OLT (median survival 16.0 vs 6.4 yrs, respectively, P < 0.001). By multivariate analysis, OLT for HCC was significantly associated with poorer overall survival (hazard ratio [HR] 2.19, 95% confidence interval [CI]: 2.02-2.37, P < 0.001). Our results indicate that outcomes for liver transplantation vary by primary hepatic pathology with HCC patients having the poorest overall survival. To optimize organ allocation for all patients with end-stage liver disease, a better understanding of poor survival for HCC is necessary.
authors.affiliation: Department of Oncologic Surgery, City of Hope, Duarte, California 91010, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Mailey
authors.forename: Brian
authors.initials: B
authors.lastname: Buchberg
authors.forename: Christie
authors.initials: C
authors.lastname: Prendergast
authors.forename: Avo
authors.initials: A
authors.lastname: Artinyan
authors.forename: Joshua
authors.initials: J
authors.lastname: Khalili
authors.forename: Nicelio
authors.initials: N
authors.lastname: Sanchez-Luege
authors.forename: Steven D
authors.initials: SD
authors.lastname: Colquhoun
authors.forename: Joseph
authors.initials: J
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology