title: Analysis of adult 20-year survivors after liver transplantation.
abstract: BACKGROUND
  Liver transplantation (LT) is the treatment of choice for chronic and acute liver failure; however, the status of long-term survivors and allograft function is not well known.
  
  
  OBJECTIVE
  To evaluate the clinical outcome and allograft function of survivors 20 years post-LT, cause of death during the same period and risk factors of mortality.
  
  
  METHODS
  A retrospective study was conducted from prospective, longitudinal data collected at a single center of adult LT recipients surviving 20 years. A comparative sub-analysis was made with patients who were not alive 20 years post-transplantation to identify the causes of death and risk factors of mortality.
  
  
  RESULTS
  Between 1988 and 1994, 132 patients received 151 deceased-donors LT and 28 (21%) survived more than 20 years. Regarding liver function in this group, medians of AST, ALT and total bilirubin at 20 years post-LT were 33 IU/L (13-135 IU/L), 27 (11-152 IU/L) and 0.6 mg/dL (0.3-1.1 mg/dL). Renal dysfunction was observed in 40% of patients and median eGFR among 20-year survivors was 64 mL/min/1.73 m(2) (6-144 mL/min/1.73 m(2)). Sixty-one percent of 20-year survivors had arterial hypertension, 43% dyslipidemia, 25% de novo tumors and 21% diabetes mellitus. Infections were the main cause of death during the 1st year post-transplant (32%) and between the 1st and 5th year post-transplant (25%). After 5th year from transplant, hepatitis C recurrence (22%) became the first cause of death. Factors having an impact on long-term patient survival were HCC indication (p = 0.049), pre-transplant renal dysfunction (p = 0.043) and long warm ischemia time (p = 0.016); furthermore, post-transplant factors were diabetes mellitus (p = 0.001) and liver dysfunction (p = 0.05) at 1 year.
  
  
  CONCLUSIONS
  Our results showed the effect of immunosuppression used during decades on long-term outcome in our LT patients in terms of morbidity (arterial hypertension, diabetes mellitus, dyslipidemia and renal dysfunction) and mortality (infections and hepatitis C recurrence).
authors: Department of HBP Surgery and Transplants, Hospital Universitario Vall d´Hebron, Universidad Autónoma de Barcelona, Paseo Vall d´Hebron 119-129, 08035, Barcelona, Spain, cdopazo@vhebron.net.
authors: C
authors: C
authors: Dopazo
authors: I
authors: I
authors: Bilbao
authors: L L
authors: LL
authors: Castells
authors: G
authors: G
authors: Sapisochin
authors: C
authors: C
authors: Moreiras
authors: I
authors: I
authors: Campos-Varela
authors: J
authors: J
authors: Echeverri
authors: M
authors: M
authors: Caralt
authors: J L
authors: JL
authors: Lázaro
authors: R
authors: R
authors: Charco
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D003920:Diabetes Mellitus / Q000401:mortality; D050171:Dyslipidemias / Q000401:mortality; D005260:Female; D006526:Hepatitis C / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000401:mortality; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000401:mortality; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D055815:Young Adult