title: Why do patients die after a liver transplantation?
abstract: As more patients achieve long-term survival, it has become important to understand mortality in liver transplantation (LT) recipients.
  
  
  
  We conducted retrospective reviews of long-term outcome in two adult LT cohorts: 85 031 in the United Network for Organ Sharing (UNOS) database and 1458 transplanted at the University of Wisconsin (UW).
  
  
  
  During median follow-up of 3.2 years (UNOS) and 6.6 years (UW), 35.1% of UNOS patients and 44.2% of UW patients died; 43.1% of all UNOS deaths occurred in year 1 compared to 25.1% in the UW cohort. Deaths due to infection (other than viral hepatitis) or cardiovascular (CV) causes were most frequent in year 1 in both cohorts and then persisted at lower rates. In contrast, death from malignancy increased after year 1 to peak in years 1-5. Deaths due to rejection, hepatitis, or graft failure were infrequent. In the UW cohort, de novo malignancy was more common than recurrent tumor and correlated with smoking history.
  
  
  
  A coordinated holistic approach that focuses on limiting immunosuppression, infection, risky behaviors, and CV risks, while screening for cancer, is needed to extend the healthy lives of LT recipients.
authors.affiliation: Departments of Medicine and Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Kim E
authors.initials: KE
authors.lastname: Daniel
authors.affiliation: Departments of Medicine and Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Jens
authors.initials: J
authors.lastname: Eickhoff
authors.affiliation: Departments of Medicine and Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Lucey
mesh_terms: D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors
keywords: cause of death; infection; liver transplantation; long-term survivors; malignancy; mortality