title: Can liver transplantation provide the statistical cure?
abstract: Liver transplantation (LT) represents the only chance of long-term survival for patients with end-stage liver disease. When the mortality rate for transplant patients returns to the same level as that for the general population, they can be considered statistically cured. However, cure models in the setting of LT have never been applied. Data from 1371 adult patients undergoing LT for the first time between January 1999 and December 2012 at 2 Italian centers were reviewed in order to establish probabilities of being cured by LT. A parametric Weibull model was applied to compare the mortality rate after LT to the rate expected for the general population (matched by sex and age). The observed 3-, 5-, and 10-year overall survival rates after LT were 77.8%, 73.3%, and 65.6%, respectively, and they did not differ between the 2 centers (P = 0.37). The cure fraction for the entire study population was 63.4% (95% confidence interval = 52.6%-72.0%), and the time to cure was 10 years with a 90% confidence level. The best cure fraction was observed for younger recipients without hepatitis C virus (HCV) who had favorable donor-recipient matches, that is, low Donor Model for End-Stage Liver Disease (D-MELD) scores (90.1%); conversely, the lowest probability was observed for elderly HCV recipients with high D-MELD scores (34.6%). The time to cure was 6.22 years for non-HCV patients and 14.78 years for HCV patients. The median survival time for uncured patients was 2.29 years. Among uncured recipients, the longest survival time was observed for younger patients (7.31 years). In conclusion, we provide here a new clinical measure for LT suggesting that survival after transplantation can approximate that of the general population and provide a statistical cure.
authors.affiliation: Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vitale
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.forename: Martina
authors.initials: M
authors.lastname: Gambato
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Maroni
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.forename: Antonio D
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D003627:Data Interpretation, Statistical; D058625:End Stage Liver Disease / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006085:Graft Survival; D006526:Hepatitis C / Q000628:therapy; D006801:Humans; D007558:Italy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011336:Probability; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult