title: [Long-term follow-up of the first 500 liver transplant recipients transplanted at the Institute for Clinical and Experimental Medicine in Prague].
abstract: BACKGROUND
  Between April 1995 and November 2005, 500 liver transplantations were performed in 476 patients of age from 3, till 70, at the Transplantation center of the Institute of Clinical and Experimental Medicine (IKEM) in Prague. The most common indications for liver transplantation were alcoholic liver cirrhosis (23%), hepatitis C cirrhosis (17%), and cholestatic cirrhosis (PBC and PSC, 9% each). Mean MELD score of recipients at the transplantation was 15-18 for each year of transplantation. Ten-years patient survival was 79.1 +/- 2.2%, and graft survival 74.1 +/- 2.1% respectively. Best patient and graft survival was achieved among patients transplanted for autoimmune liver diseases, the worst in group of patients with alcoholic cirrhosis. Malignancies were the most common cause of death during the period of follow-up (17 patients).
  
  
  RESULTS
  Patients were followed longitudinally at the Department of hepatogastroenterology IKEM according to prospective protocol included protocol biopsies. Hypertension (in 71% of recipients), and overweight or obesity (in 56.3%), were the most prevalent medical complications among long-term survivors. Diabetes was found in 28.6%, of which 14.7% was de-nove diabetes after transplantation. Renal insufficiency (S-creatinin > 150 micromol/l) was present in 61 of 348 (17.6%) survivors. Out of these, 16 needed chronic hemodialysis, and 12 underwent kidney transplantation subsequently. Protocol biopsy at 5 years after transplantation was evaluated in a sample of 102 unselected liver transplant recipients. Normal liver was found in 4% of recipients, minor non-specific changes in 36% of them. Disease recurrence was present in all of 16 recipients transplanted for HCV cirrhosis, in one third of them graft cirrhosis was already present. Disease recurrence was found in patients transplanted for autoimmune disease frequently, PBC in 40%, PSC in 25%, and autoimmune hepatitis in 60% of recipients. Graft steatosis greater than 33% was present in 13% of recipients.
  
  
  CONCLUSIONS
  Liver transplantation is highly effective method of treatment of end stage liver disease. Despite frequent medical complications, and disease recurrence on histological examination almost 80% of recipients transplanted in the liver transplantation program in IKEM survived more than 10 years after procedure. The survival achieved was far above that of the European liver transplant registry.
authors.affiliation: Institut klinické a experimentální medicíny Praha, Transplantcentrum. patr@medicon.cz
authors.forename: Pavel
authors.initials: P
authors.lastname: Trunecka
authors.forename: Milos
authors.initials: M
authors.lastname: Adamec
authors.forename: Julius
authors.initials: J
authors.lastname: Spicák
authors.forename: Eva
authors.initials: E
authors.lastname: Honsová
authors.forename: Eva
authors.initials: E
authors.lastname: Kieslichová
authors.forename: Vera
authors.initials: V
authors.lastname: Lánská
authors.forename: Jan
authors.initials: J
authors.lastname: Peregrin
authors.forename: Milos
authors.initials: M
authors.lastname: Kucera
authors.forename: Libor
authors.initials: L
authors.lastname: Janousek
authors.forename: Martin
authors.initials: M
authors.lastname: Oliverius
authors.forename: Pavel
authors.initials: P
authors.lastname: Drastich
authors.forename: Milan
authors.initials: M
authors.lastname: Rocen
authors.forename: Roman
authors.initials: R
authors.lastname: Danc
authors.forename: Halima
authors.initials: H
authors.lastname: Gottfriedová
authors.forename: Sona
authors.initials: S
authors.lastname: Franková
authors.forename: Jan
authors.initials: J
authors.lastname: Sperl
authors.forename: Eva
authors.initials: E
authors.lastname: Pokorná
authors.forename: Stefan
authors.initials: S
authors.lastname: Vítko
authors.forename: Jan
authors.initials: J
authors.lastname: Malý
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D058625:End Stage Liver Disease / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D008875:Middle Aged; D012008:Recurrence; D017741:Survivors; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents