title: Factors associated with long-term survival after liver transplantation: A retrospective cohort study.
abstract: OBJECTIVE
  To identify predictive factors associated with long-term patient and graft survival (> 15 years) in liver transplant recipients.
  
  
  METHODS
  Medical charts of allde novoadult liver transplant recipients (n= 140) who were transplanted in Hamburg between 1997 and 1999 were retrospectively reviewed. In total, 155 transplantations were identified in this time period (15 re-transplantations). Twenty-six orthotopic liver transplant (OLT) recipients were early lost to follow-up due to moving to other places within 1 year after transplantation. All remaining 114 patients were included in the analysis. The following recipient factors were analysed: Age, sex, underlying liver disease, pre-OLT body mass index (BMI), and levels of alanine aminotransferase (ALT), bilirubin, creatinine and gamma-glutamyltransferase (gamma-GT), as well as warm and cold ischemia times. Furthermore, the following donor factors were assessed: Age, BMI, cold ischemia time and warm ischemia time. All surviving patients were followed until December 2014. We divided patients into groups according to their underlying diagnosis: (1) hepatocellular carcinoma (n= 5, 4%); (2) alcohol toxic liver disease (n= 25, 22.0%); (3) primary sclerosing cholangitis (n= 6, 5%); (4) autoimmune liver diseases (n= 7, 6%); (5) hepatitis C virus cirrhosis (n= 15, 13%); (6) hepatitis B virus cirrhosis (n= 21, 19%); and (7) other (n= 35, 31%). The group "other" included rare diagnoses, such as acute liver failure, unknown liver failure, stenosis and thrombosis of the arteria hepatica, polycystic liver disease, Morbus Osler and Caroli disease.
  
  
  RESULTS
  The majority of patients were male (n= 70, 61%). Age and BMI at the time point of transplantation ranged from 16 years to 69 years (median: 53 years) and from 15 kg/m2to 33 kg/m2(median: 24), respectively. Sixty-six OLT recipients (58%) experienced a follow-up of 15 years after transplantation. Recipient's age (P= 0.009) and BMI (P= 0.029) were identified as risk factors for death byχ2-test. Kaplan-Meier analysis confirmed BMI or age above the median as predictors of decreased long-term survival (P= 0.008 andP= 0.020). Hepatitis B as underlying disease showed a trend for improved long-term survival (P= 0.049,χ2-test,P= 0.055; Kaplan-Meier analysis, Log rank). Pre-transplant bilirubin, creatinine, ALT and gamma-GT levels were not associated with survival in these patients of the pre-era of the model of end stage liver disease.
  
  
  CONCLUSIONS
  The recipients' age and BMI were predictors of long-term survival after OLT, as well as hepatitis B as underlying disease. In contrast, donors' age and BMI were not associated with decreased survival. These findings indicate that recipient factors especially have a high impact on long-term outcome after liver transplantation.
authors.affiliation: Sven Pischke, Marie C Lege, Moritz von Wulffen, Antonio Galante, Benjamin Otto, Malte H Wehmeyer, Ansgar W Lohse, Martina Sterneck, Department of Medicine I, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Pischke
authors.affiliation: Sven Pischke, Marie C Lege, Moritz von Wulffen, Antonio Galante, Benjamin Otto, Malte H Wehmeyer, Ansgar W Lohse, Martina Sterneck, Department of Medicine I, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: Marie C
authors.initials: MC
authors.lastname: Lege
authors.affiliation: Sven Pischke, Marie C Lege, Moritz von Wulffen, Antonio Galante, Benjamin Otto, Malte H Wehmeyer, Ansgar W Lohse, Martina Sterneck, Department of Medicine I, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: von Wulffen
authors.affiliation: Sven Pischke, Marie C Lege, Moritz von Wulffen, Antonio Galante, Benjamin Otto, Malte H Wehmeyer, Ansgar W Lohse, Martina Sterneck, Department of Medicine I, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: Antonio
authors.initials: A
authors.lastname: Galante
authors.affiliation: Sven Pischke, Marie C Lege, Moritz von Wulffen, Antonio Galante, Benjamin Otto, Malte H Wehmeyer, Ansgar W Lohse, Martina Sterneck, Department of Medicine I, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Otto
authors.affiliation: Sven Pischke, Marie C Lege, Moritz von Wulffen, Antonio Galante, Benjamin Otto, Malte H Wehmeyer, Ansgar W Lohse, Martina Sterneck, Department of Medicine I, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: Malte H
authors.initials: MH
authors.lastname: Wehmeyer
authors.affiliation: Sven Pischke, Marie C Lege, Moritz von Wulffen, Antonio Galante, Benjamin Otto, Malte H Wehmeyer, Ansgar W Lohse, Martina Sterneck, Department of Medicine I, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: Uta
authors.initials: U
authors.lastname: Herden
authors.affiliation: Sven Pischke, Marie C Lege, Moritz von Wulffen, Antonio Galante, Benjamin Otto, Malte H Wehmeyer, Ansgar W Lohse, Martina Sterneck, Department of Medicine I, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Fischer
authors.affiliation: Sven Pischke, Marie C Lege, Moritz von Wulffen, Antonio Galante, Benjamin Otto, Malte H Wehmeyer, Ansgar W Lohse, Martina Sterneck, Department of Medicine I, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Nashan
authors.affiliation: Sven Pischke, Marie C Lege, Moritz von Wulffen, Antonio Galante, Benjamin Otto, Malte H Wehmeyer, Ansgar W Lohse, Martina Sterneck, Department of Medicine I, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: Ansgar W
authors.initials: AW
authors.lastname: Lohse
authors.affiliation: Sven Pischke, Marie C Lege, Moritz von Wulffen, Antonio Galante, Benjamin Otto, Malte H Wehmeyer, Ansgar W Lohse, Martina Sterneck, Department of Medicine I, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Sterneck
keywords: Age; Body mass index; Hepatitis B; Liver transplantation; Long-term survival