title: Long-term patient outcome and quality of life after liver transplantation: analysis of 20-year survivors.
abstract: OBJECTIVE
  To evaluate patient survival and allograft function and health-related quality of life (HRQOL) 20 years after orthotopic liver transplantation (LT).
  
  
  BACKGROUND
  Although LT is the established treatment of choice for acute and chronic liver failure, allograft function and recipient HRQOL 20 years after LT remain undefined.
  
  
  METHODS
  We performed a prospective, cross-sectional study of LT recipients surviving 20 years or more. Clinical data were reviewed to identify factors associated with 20-year survival. Survivors were directly contacted and offered a survey to assess HRQOL (SF-36; Liver Disease Quality of Life), social support, and cognition (Neuropsychological Impairment Scale). Logistic regression analysis was performed to identify clinical factors influencing HRQOL 20 years after LT.
  
  
  RESULTS
  Between February 1, 1984 and December 31, 1988, a total of 293 patients (179 adults, 114 children) received 348 LTs. Of the 293 patients, 168 (56%) survived for 20 years or more. Actuarial 20-year survival was 52% (patient) and 42% (graft). Factors associated with 20-year survival included recipient age <18 (P = 0.01), nonurgent LT (P = 0.01), no retransplantation (0.02), female gender (0.03), absence of biliary complications (P = 0.04), and short total ischemia time (P = 0.05). Rejection episodes were seen in a greater proportion of 20-year survivors than in nonsurvivors (35% vs. 27%; P = 0.3). Of the 168 survivors, 87 were contacted, and 68 (78%) completed the HRQOL surveys. Compared with the general population, survivors had lower physical scores (P < 0.01) but comparable mental scores on the SF-36. Overall HRQOL was significantly better in 20-year survivors than in patients with chronic liver disease, congestive heart failure, or diabetes. Clinical factors associated with improved post-LT HRQOL were younger age at LT, allograft longevity, and strong social support. More than 90% of pediatric survivors completed high school. After LT, 34% of pediatric recipients married, and 79% remained married at 20 years' follow-up.
  
  
  CONCLUSIONS
  More than 50% of LT recipients survive 20 years, achieve important socioeconomic milestones, and report quality of life superior to patients with liver disease or other chronic conditions. LT is a durable surgery that restores both long-term physiologic and psychologic well-being in patients with end-stage liver disease.
authors.affiliation: Department of Surgery, Dumont-UCLA Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Duffy
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kao
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Farmer
authors.forename: Sue V
authors.initials: SV
authors.lastname: McDiarmid
authors.forename: Johnny C
authors.initials: JC
authors.lastname: Hong
authors.forename: Robert S
authors.initials: RS
authors.lastname: Venick
authors.forename: Susan
authors.initials: S
authors.lastname: Feist
authors.forename: Leonard
authors.initials: L
authors.lastname: Goldstein
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Hiatt
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
mesh_terms: D000328:Adult; D000367:Age Factors; D001649:Bile Duct Diseases / Q000150:complications; D002648:Child; D003430:Cross-Sectional Studies; D004493:Education; D004651:Employment; D005260:Female; D006084:Graft Rejection; D006801:Humans; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D011446:Prospective Studies; D011788:Quality of Life; D012737:Sex Factors; D012944:Social Support; D016896:Treatment Outcome