CAUSES OF LATE MORTALITY IN SURVIVORS OF LIVER TRANSPLANTATION.

Abstract

85 This study was undertaken to determine the incidence, timing, and causes of death in patients who have survived more than one year after liver transplantation (LT). Methods: A retrospective study of 686 patients who survived more than one year after LT revealed 127 patients (18.5%) subsequently died (median f/u = 5.2 years). The causes of death are listed in the table below. Univariate analysis using the Cox Proportional Hazards model was used to determine if age, gender, primary disease, and length of survival were predictive for the causes of death.TableResults: The 10-year actuarial survival was 71% (based on 100% survival at one year). The four most common causes of death were graft failure, malignancy, recurrent disease and cardiac disease. Age and male gender were the only risk factors affecting cause of death. Patients who underwent liver transplant after age 55 were 2.9 times more likely to die from de novo malignancies and 4.5 times more likely to die from cardiovascular disease. Male patients were 3.2 times more likely to die from recurrent disease and 2.4 times more likely to die from de novo malignancy. Conclusions: Allograft failure due to chronic rejection or recurrence of the primary disease (especially hepatitis C) accounts for 40% of late mortality after LT. To achieve improvement in survival over the current rates attention must be focused on the prevention of these two processes. In the absence of allograft failure, the most common causes of death were the same as in the nontransplant population. Older patients and males may further benefit from increased cancer surveillance or improved immunosuppression.