NIV Congres

Aims To analyze long-term outcome of nearly two decades of auxiliary (AXLT) and orthotopic (OLT) liver transplantation (LT) in a single center.

Methods A retrospective analysis was performed on patient and graft survival and its determinants in the 348 consecutive LTs performed in nearly 20 years at our institution. Sept. 1992- Dec. 2001 was considered the first decade and Jan. 2002-l March 2011 the second decade.

Results A total of 335 OLTs en 13 AXLTs were performed in the studied time-period using 303 donor livers from donation after brain death (DBD) and –from 2001 on- 45 with donation after cardiac death (DCD). Hepatocellular carcinoma (HCC) was the main reason for OLT in both decades (13.4% vs 19.5%, p=0.11) followed by alcoholic liver disease (ALD). Hepatic artery thrombosis (HAT) was the main reason for retransplantation in both decades for DBD-LTs (5-year cumulative incidence (CI) HAT 6.8% vs 3.9%, p=0.22) whereas retransplantation due to biliary strictures was significantly higher for DCD-LTs compared to DBD-LTs (5-year CI 14% vs 5.1%, respectively, p<0.01). Patient and graft survival had significantly improved in the second decade versus the first decade (10-year patient survival 83% vs. 52%; log rank p<0.01, graft survival 68% vs. 41% respectively; log rank p<0.01). Post-LT infection was the main cause of patient mortality in both decades although a significant decrease was noticed in the second decade (10-year cumulative incidence13.3% vs 3.8%, respectively p<0.01). Death from recurrent primary disease (mainly HCC) decreased from 11.6% to 1.4% (p<0.01). DBD livers had lower cold ischemic times (CIT) and lower recipient warm ischemic times (RWIT) in the second decade compared to the first decade (CIT 709 minutes vs. 591 minutes; p<0.01 and RWIT 42 min vs. 35 min; p<0.01, respectively) and DCD donors had lower CITs compared to DBD donors in the second decade (487 minutes vs. 591 minutes, respectively; p<0.01). With multivariate analysis over all 20 years acute liver failure as transplantation indication(HR=2.80, p=0.03), blood loss during surgery (HR=1.06, p=<0.01) and decade of liver transplantation (HR=2.54, p=0.01) were significant determinants of patient survival.

Conclusions Long-term patient- and graft-survival significantly improved in 20 years of liver transplantation, with less death due to infection, less recurrent primary disease and shorter ischemia times. Hepatic artery thrombosis and biliary strictures remain important causes for retransplantation.