title: The pattern of late mortality in liver transplant recipients in the United Kingdom.
abstract: BACKGROUND
  Late survival is not improving after liver transplantation. In this study, possible reasons for this were investigated.
  
  
  METHODS
  Mortality rates and causes of death were ascertained in 4483 adult primary liver allograft recipients surviving 1 year or more from engraftment, identified through the UK Transplant Database and transplanted between 1994 and 2007. Associations with death, cause of death, and retransplantation were assessed.
  
  
  RESULTS
  Mortality in those surviving beyond 1 year in UK liver transplant recipients was more than twice that expected in the general population and had not improved during the study period, independent of cause of liver disease, recipient age, recipient gender, and donor age. The major causes of death were malignancy (30.6%), multisystem failure (10.0%), infection (9.8%), cardiac disease (8.7%), and graft failure (9.8%). Associations with death after 1 year were pretransplant etiologies alcohol-related liver disease (hazard ratio [HR]=2.10), autoimmune hepatitis or cryptogenic (HR=1.68), hepatitis C virus (HR=2.51), and hepatocellular carcinoma (HR=4.19). Associations with retransplantation were recipient age (HR=0.95 per year), donor age (HR=1.02 per year), and hepatitis C virus (HR=2.04). Hepatocellular carcinoma and recipient age were associated with cancer-related death (odds ratio=1.87 and 1.02 per year). Recipient age was associated with cardiac death (odds ratio=1.06 per year).
  
  
  CONCLUSIONS
  Strategies to reduce late mortality after liver transplantation are required. These may include prevention of disease recurrence, improved recipient selection, and addressing risk factors for death in late survivors of liver transplantation.
authors.affiliation: Department of Medicine, University of Cambridge, Cambridge, United Kingdom.
authors.forename: William
authors.initials: W
authors.lastname: Gelson
authors.forename: Matthew
authors.initials: M
authors.lastname: Hoare
authors.forename: M F
authors.initials: MF
authors.lastname: Dawwas
authors.forename: Sarah
authors.initials: S
authors.lastname: Vowler
authors.forename: Paul
authors.initials: P
authors.lastname: Gibbs
authors.forename: Graeme
authors.initials: G
authors.lastname: Alexander
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006526:Hepatitis C / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006113:United Kingdom / Q000453:epidemiology