Medical epidemiology of patients surviving ten years after liver transplantation.
The transition into extended long-term follow-up after liver transplantation raises a new series of issues with respect to continuing care of this population. A retrospective study was performed, analyzing patients who underwent orthotopic liver transplant (OLT) and survived ≥10 yr at a single institution. Long-term comorbidities such as diabetes mellitus (DM), hypertension (HTN), chronic kidney disease (CKD), coronary artery disease (CAD), and obesity were identified and standardized prevalence ratios ([SPR]) utilized to compare with the general US population. There was an increased prevalence of HTN ([SPR] = 2.25 ± 0.61), DM ([SPR] = 2.67 ± 0.72), and CKD ([SPR] = 15.3 ± 4.04) but not CAD or obesity. In multivariate analysis, non-viral etiology of end-stage liver disease was associated with CKD (OR 3.42 CI 1.11-10.53), and an initial glomerular filtration rate (GFR) <60 mL/min per 1.73 m(2) (CKD stages III-V) was associated with HTN (OR 4.62 CI 1.14-18.73) after OLT. Creatinine ≥ 1.5 mg/dL at 10 yr was associated with an initial GFR <60 mL/min per 1.73 m(2) (p = 0.000) and CAD after OLT (p = 0.012). Patients, 10 yr after OLT, have a significantly higher prevalence of HTN, DM, and CKD than the general population, which is not confounded by obesity. Increased vigilance and proactive management are required to further improve long-term outcomes.
Simo
Kerri A
KA
Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Sereika
Stephanie
S
Bitner
Nathan
N
Newton
Kimberly N
KN
Gerber
David A
DA
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000209:etiology; D007165:Immunosuppression Therapy; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult