Long-Term Survival After Liver Transplantation in 4,000 Consecutive Patients at a Single Center

[Guest guest]

Ann Surg 2000 Oct;232(4):490-500

Long-Term Survival After Liver Transplantation in 4,000 Consecutive Patients

at a Single Center.

Jain A, Reyes J, Kashyap R, Dodson SF, Demetris AJ, Ruppert K, Abu-Elmagd K,

Marsh W, Madariaga J, Mazariegos G, Geller D, Bonham CA, Gayowski T,

Cacciarelli T, Fontes P, Starzl TE, Fung JJ

E. Starzl Transplantation Institute and the Departments of Surgery

and Pathology, the School of Pharmaceutical Sciences, and the Graduate

School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.

[Record supplied by publisher]

OBJECTIVE: To evaluate the long-term survival outcomes of a large cohort of

liver transplant recipients and to identify static and changing factors that

influenced these outcomes over time. SUMMARY BACKGROUND DATA: Liver

transplantation has been accepted as a therapeutic option for patients with

end-stage liver disease since 1983, with continual improvements in patient

survival as a result of advances in immunosuppression and medical

management, technical achievements, and improvements in procurement and

preservation. Although many reports, including registry data, have

delineated short-term factors that influence survival, few reports have

examined factors that affect long-term survival after liver transplantation.

METHODS: Four thousand consecutive patients who underwent liver

transplantation between February 1981 and April 1998 were included in this

analysis and were followed up to March 2000. The effect of donor and

recipient age at the time of transplantation, recipient gender, diagnosis,

and year of transplantation were compared. Rates of retransplantation,

causes of retransplantation, and cause of death were also examined. RESULTS:

The overall patient survival for the entire cohort was 59%; the actuarial

18-year survival was 48%. Patient survival was significantly better in

children, in female recipients, and in patients who received transplants

after 1990. The rates of retransplantation for acute or chronic rejection

were significantly lower with tacrolimus-based immunosuppression. The risk

of graft failure and death was relatively stable after the first year, with

recurrence of disease, malignancies, and age-related complications being the

major factors for loss. CONCLUSION: Significantly improved patient and graft

survival has been observed over time, and graft loss from acute or chronic

rejection has emerged as a rarity. Age-related and disease-related causes of

graft loss represent the greatest threat to long-term survival.

PMID: 10998647

[Guest guest]

Ann Surg 2000 Oct;232(4):490-500

Long-Term Survival After Liver Transplantation in 4,000 Consecutive Patients

at a Single Center.

Jain A, Reyes J, Kashyap R, Dodson SF, Demetris AJ, Ruppert K, Abu-Elmagd K,

Marsh W, Madariaga J, Mazariegos G, Geller D, Bonham CA, Gayowski T,

Cacciarelli T, Fontes P, Starzl TE, Fung JJ

E. Starzl Transplantation Institute and the Departments of Surgery

and Pathology, the School of Pharmaceutical Sciences, and the Graduate

School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.

[Record supplied by publisher]

OBJECTIVE: To evaluate the long-term survival outcomes of a large cohort of

liver transplant recipients and to identify static and changing factors that

influenced these outcomes over time. SUMMARY BACKGROUND DATA: Liver

transplantation has been accepted as a therapeutic option for patients with

end-stage liver disease since 1983, with continual improvements in patient

survival as a result of advances in immunosuppression and medical

management, technical achievements, and improvements in procurement and

preservation. Although many reports, including registry data, have

delineated short-term factors that influence survival, few reports have

examined factors that affect long-term survival after liver transplantation.

METHODS: Four thousand consecutive patients who underwent liver

transplantation between February 1981 and April 1998 were included in this

analysis and were followed up to March 2000. The effect of donor and

recipient age at the time of transplantation, recipient gender, diagnosis,

and year of transplantation were compared. Rates of retransplantation,

causes of retransplantation, and cause of death were also examined. RESULTS:

The overall patient survival for the entire cohort was 59%; the actuarial

18-year survival was 48%. Patient survival was significantly better in

children, in female recipients, and in patients who received transplants

after 1990. The rates of retransplantation for acute or chronic rejection

were significantly lower with tacrolimus-based immunosuppression. The risk

of graft failure and death was relatively stable after the first year, with

recurrence of disease, malignancies, and age-related complications being the

major factors for loss. CONCLUSION: Significantly improved patient and graft

survival has been observed over time, and graft loss from acute or chronic

rejection has emerged as a rarity. Age-related and disease-related causes of

graft loss represent the greatest threat to long-term survival.

PMID: 10998647

[Guest guest]

Ann Surg 2000 Oct;232(4):490-500

Long-Term Survival After Liver Transplantation in 4,000 Consecutive Patients

at a Single Center.

Jain A, Reyes J, Kashyap R, Dodson SF, Demetris AJ, Ruppert K, Abu-Elmagd K,

Marsh W, Madariaga J, Mazariegos G, Geller D, Bonham CA, Gayowski T,

Cacciarelli T, Fontes P, Starzl TE, Fung JJ

E. Starzl Transplantation Institute and the Departments of Surgery

and Pathology, the School of Pharmaceutical Sciences, and the Graduate

School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.

[Record supplied by publisher]

OBJECTIVE: To evaluate the long-term survival outcomes of a large cohort of

liver transplant recipients and to identify static and changing factors that

influenced these outcomes over time. SUMMARY BACKGROUND DATA: Liver

transplantation has been accepted as a therapeutic option for patients with

end-stage liver disease since 1983, with continual improvements in patient

survival as a result of advances in immunosuppression and medical

management, technical achievements, and improvements in procurement and

preservation. Although many reports, including registry data, have

delineated short-term factors that influence survival, few reports have

examined factors that affect long-term survival after liver transplantation.

METHODS: Four thousand consecutive patients who underwent liver

transplantation between February 1981 and April 1998 were included in this

analysis and were followed up to March 2000. The effect of donor and

recipient age at the time of transplantation, recipient gender, diagnosis,

and year of transplantation were compared. Rates of retransplantation,

causes of retransplantation, and cause of death were also examined. RESULTS:

The overall patient survival for the entire cohort was 59%; the actuarial

18-year survival was 48%. Patient survival was significantly better in

children, in female recipients, and in patients who received transplants

after 1990. The rates of retransplantation for acute or chronic rejection

were significantly lower with tacrolimus-based immunosuppression. The risk

of graft failure and death was relatively stable after the first year, with

recurrence of disease, malignancies, and age-related complications being the

major factors for loss. CONCLUSION: Significantly improved patient and graft

survival has been observed over time, and graft loss from acute or chronic

rejection has emerged as a rarity. Age-related and disease-related causes of

graft loss represent the greatest threat to long-term survival.

PMID: 10998647

[Guest guest]

Ann Surg 2000 Oct;232(4):490-500

Long-Term Survival After Liver Transplantation in 4,000 Consecutive Patients

at a Single Center.

Jain A, Reyes J, Kashyap R, Dodson SF, Demetris AJ, Ruppert K, Abu-Elmagd K,

Marsh W, Madariaga J, Mazariegos G, Geller D, Bonham CA, Gayowski T,

Cacciarelli T, Fontes P, Starzl TE, Fung JJ

E. Starzl Transplantation Institute and the Departments of Surgery

and Pathology, the School of Pharmaceutical Sciences, and the Graduate

School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.

[Record supplied by publisher]

OBJECTIVE: To evaluate the long-term survival outcomes of a large cohort of

liver transplant recipients and to identify static and changing factors that

influenced these outcomes over time. SUMMARY BACKGROUND DATA: Liver

transplantation has been accepted as a therapeutic option for patients with

end-stage liver disease since 1983, with continual improvements in patient

survival as a result of advances in immunosuppression and medical

management, technical achievements, and improvements in procurement and

preservation. Although many reports, including registry data, have

delineated short-term factors that influence survival, few reports have

examined factors that affect long-term survival after liver transplantation.

METHODS: Four thousand consecutive patients who underwent liver

transplantation between February 1981 and April 1998 were included in this

analysis and were followed up to March 2000. The effect of donor and

recipient age at the time of transplantation, recipient gender, diagnosis,

and year of transplantation were compared. Rates of retransplantation,

causes of retransplantation, and cause of death were also examined. RESULTS:

The overall patient survival for the entire cohort was 59%; the actuarial

18-year survival was 48%. Patient survival was significantly better in

children, in female recipients, and in patients who received transplants

after 1990. The rates of retransplantation for acute or chronic rejection

were significantly lower with tacrolimus-based immunosuppression. The risk

of graft failure and death was relatively stable after the first year, with

recurrence of disease, malignancies, and age-related complications being the

major factors for loss. CONCLUSION: Significantly improved patient and graft

survival has been observed over time, and graft loss from acute or chronic

rejection has emerged as a rarity. Age-related and disease-related causes of

graft loss represent the greatest threat to long-term survival.

PMID: 10998647