title: Long-term outcome of 'long-term liver transplant survivors'.
abstract: There are few studies focusing on long-term complications in liver transplant (LT) recipients. The aim of this study was to define the outcome of LT recipients having survived at least 10 years from LT. Of 323 adult LT done between 1991 and 1997, the 167(52%) alive >10 years post-LT (baseline time) formed the study population. Long-term outcome measures included the following: immunosuppression, metabolic complications [obesity, arterial hypertension (AH), diabetes, dislypidemia], cardiovascular events (CVE), chronic renal dysfunction-CRD, and de novo tumors. Median age at LT was 50 years. Most common indication was postnecrotic cirrhosis (89%), mostly because of HCV (46%). At study-baseline (10 years post-LT), 29% were obese and AH, diabetes, dislypidemia, and CRD were present in 75%, 30%, 42%, and 36%, respectively. In most cases, these complications were already present 1 year post-LT; less than one quarter developed them onward. The 6 year cumulative survival since baseline reached 84% (n = 24 deaths), with most deaths related to recurrent graft diseases (mostly HCV) followed by de novo tumors or CVE. 1, 3, 5 and 10 years cumulative rates of CVE and de novo tumors since baseline were 2%, 5%, 10% and 17%, and 1%, 3%, 6% and 13%, respectively. Chronic renal impairment was independently associated with survival and development of CVE since baseline. The medium-term survival of 'long-term survivors', i.e. patients alive 10 years after LT is good, but metabolic complications and CRD are common and continue to increase afterwards. Cardiovascular events and de novo tumors increase gradually over time and represent a major cause of late mortality.
authors.affiliation: Liver Transplantation and Hepatology Unit, La Fe Hospital, Valencia, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Rubín
authors.forename: Cristina
authors.initials: C
authors.lastname: Sánchez-Montes
authors.forename: Victoria
authors.initials: V
authors.lastname: Aguilera
authors.forename: Fernando San
authors.initials: FS
authors.lastname: Juan
authors.forename: Isabel
authors.initials: I
authors.lastname: Ferrer
authors.forename: Angel
authors.initials: A
authors.lastname: Moya
authors.forename: Eva
authors.initials: E
authors.lastname: Montalva
authors.forename: Eugenia
authors.initials: E
authors.lastname: Pareja
authors.forename: Rafael
authors.initials: R
authors.lastname: López-Andujar
authors.forename: Martín
authors.initials: M
authors.lastname: Prieto
authors.forename: Marina
authors.initials: M
authors.lastname: Berenguer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors; D016896:Treatment Outcome