THE RESULTS after liver transplantation (LTx) have improved significantly over the last two decades.1 However, a significant number of patients die both in the short- and long-term posttransplant period. The aim the present study is to evaluate the causes of death and the rate of death after liver transplantation from a single center.
MATERIAL AND METHODS
The study subjects are 4000 consecutive patients who underwent LTx since the inception of the program at our institution from February 1981 to April 1998. All patients were followed until November 1999. Mean follow-up was 9.4 ± 3.8 years (median 9.6: range 2 to 19 years). The details of the population have been described elsewhere.2
RESULTS
Causes of Death
One thousand six hundred thirty-three patients (40.8%) have died during the follow-up period. The causes of death at various time intervals from transplant are shown in Table 1. Infection has remained the most common cause of death at all time points, comprising 28.4% of the deaths. This was followed with recurrent or de novo cancers (11.6%), cardiovascular (8.3%), and respiratory (7.0%) causes. The rate of death is shown in the Fig 1. Nearly three fourths of these died within the first 3 months (20.4%). As expected, the highest mortality occurred in the first year after LTx. Mortality after 2 years is about 3 to 4% per year, often as a result of age-related complications. Overall survival has improved significantly over time.
Table 1.
Causes of Death
| Years Posttransplantation | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | >10 | Total n (%) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Patient at risk (n) | 4000 | 2940 | 2685 | 2478 | 2261 | 2018 | 1732 | 1511 | 1238 | 958 | 735 | |
| Infection (bacterial, viral, fungal) |
372 | 38 | 13 | 16 | 4 | 6 | 8 | 1 | 3 | 1 | 2 | 464 (28.4) |
| Malignancy (recurrent/de novo) | 42 | 45 | 28 | 18 | 11 | 19 | 12 | 6 | 3 | 6 | 190 (11.6) | |
| Cardiovascular | 42 | 14 | 6 | 1 | 13 | 17 | 13 | 9 | 6 | 5 | 9 | 135 (8.3) |
| Respiratory | 37 | 20 | 14 | 7 | 8 | 3 | 3 | 4 | 5 | 4 | 9 | 114 (7.0) |
| Intraoperative | 99 | 4 | 1 | 2 | 4 | 2 | 1 | 113 (6.9) | ||||
| Multisystem organ failure | 45 | 16 | 9 | 5 | 6 | 9 | 5 | 7 | 3 | 1 | 3 | 109 (6.7) |
| Liver failure (recurrent) | 21 | 15 | 15 | 7 | 10 | 6 | 3 | 2 | 1 | 2 | 82 (5.9) | |
| Gastrointestinal | 31 | 6 | 2 | 4 | 5 | 1 | 1 | 1 | 1 | 52 (3.2) | ||
| Central nervous system | 20 | 2 | 2 | 4 | 1 | 5 | 3 | 1 | 4 | 42 (2.6) | ||
| PTLD | 8 | 5 | 6 | 2 | 3 | 1 | 1 | 1 | 2 | 29 (1.8) | ||
| Renal failure | 8 | 5 | 1 | 3 | 1 | 18 (1.1) | ||||||
| Rejection (acute/chronic) | 4 | 2 | 1 | 1 | 1 | 2 | 2 | 1 | 4 | 18 (1.1) | ||
| Primary nonfunction | 13 | 1 | 14 (1.1) | |||||||||
| Miscellaneous | 27 | 15 | 7 | 12 | 10 | 12 | 8 | 10 | 7 | 5 | 5 | 118 (6.1) |
| Unknown | 55 | 20 | 18 | 5 | 5 | 7 | 4 | 5 | 4 | 1 | 11 | 135 (8.3) |
| Total n (%) | 816 (20.4) | 197 (6.7) | 122 (4.5) | 96 (3.8) | 85 (3.7) | 93 (4.6) | 62 (3.5) | 50 (3.3) | 36 (2.9) | 19 (1.9) | 57 (7.7) | 1633 |
PTLD, posttransplant lymphoproliferative disease.
Fig 1.
Proportion of death (X axis) vs years posttransplant (Y axis).
REFERENCES
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