Evaluating twenty-years of follow-up after orthotopic liver transplantation, best practice for donor-recipient matching: What can we learn from the past era?
OBJECTIVE
To characterize major determinants of 20-year survival after liver transplantation (LT).


METHODS
This longitudinal single-institution study includes 313 consecutive patients who received a LT between 1988 and 1992. Pretransplant clinical characteristics and laboratory values were assessed and compared between 20-year survivors and non-survivors. Particular attention was paid to the Model for End-Stage Liver Disease (labMELD)-score and the Eurotransplant Donor Risk Index (ET-DRI) to unravel their impact on 20-year survival after LT.


RESULTS
Twenty-year survivors were significantly younger (44 vs 50 years, P = 0.001), more likely to be female (49% vs 36%, P = 0.03) and less likely to be obese at the time of LT (19% vs 32%, P = 0.011). Mean labMELD-score (P = 0.156), rate of high-urgency LT (P = 0.210), cold-ischemia time (P = 0.994), rate of retransplantation (P = 0.12) and average donor age (28 vs 33 years, P = 0.099) were not statistically different. The mean estimated glomerular filtration rate was higher among survivors (P = 0.007). ET-DRI > 1.4 (P = 0.020) and donor age ≥ 30 years (P < 0.022) had significant influence on 20-year survival. The overall survival was not significantly impacted by labMELD-score categories (P = 0.263).


CONCLUSIONS
LT offers excellent long-term results in case of optimal donor and recipient conditions. However, mainly due to the current organ shortage, these ideal circumstances are rarely given; thus algorithms for donor-recipient matching need to be refined, in order to enable a maximum benefit for the recipients of high quality as well as marginal organs.
Niklas Buescher, Daniel Seehofer, Michael Helbig, Andreas Andreou, Marcus Bahra, Andreas Pascher, Johann Pratschke, Wenzel Schoening, Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow Klinikum, 13465 Berlin, Germany.
Niklas
N
Buescher
Niklas Buescher, Daniel Seehofer, Michael Helbig, Andreas Andreou, Marcus Bahra, Andreas Pascher, Johann Pratschke, Wenzel Schoening, Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow Klinikum, 13465 Berlin, Germany.
Daniel
D
Seehofer
Niklas Buescher, Daniel Seehofer, Michael Helbig, Andreas Andreou, Marcus Bahra, Andreas Pascher, Johann Pratschke, Wenzel Schoening, Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow Klinikum, 13465 Berlin, Germany.
Michael
M
Helbig
Niklas Buescher, Daniel Seehofer, Michael Helbig, Andreas Andreou, Marcus Bahra, Andreas Pascher, Johann Pratschke, Wenzel Schoening, Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow Klinikum, 13465 Berlin, Germany.
Andreas
A
Andreou
Niklas Buescher, Daniel Seehofer, Michael Helbig, Andreas Andreou, Marcus Bahra, Andreas Pascher, Johann Pratschke, Wenzel Schoening, Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow Klinikum, 13465 Berlin, Germany.
Marcus
M
Bahra
Niklas Buescher, Daniel Seehofer, Michael Helbig, Andreas Andreou, Marcus Bahra, Andreas Pascher, Johann Pratschke, Wenzel Schoening, Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow Klinikum, 13465 Berlin, Germany.
Andreas
A
Pascher
Niklas Buescher, Daniel Seehofer, Michael Helbig, Andreas Andreou, Marcus Bahra, Andreas Pascher, Johann Pratschke, Wenzel Schoening, Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow Klinikum, 13465 Berlin, Germany.
Johann
J
Pratschke
Niklas Buescher, Daniel Seehofer, Michael Helbig, Andreas Andreou, Marcus Bahra, Andreas Pascher, Johann Pratschke, Wenzel Schoening, Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow Klinikum, 13465 Berlin, Germany.
Wenzel
W
Schoening
Donor-recipient matching; Ideal recipient; Liver transplantation; Long-term outcome; Recipient characteristics
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