Analysis of long-term outcomes after liver transplantation in the Department of General,Transplant and Liver Surgery at the Medical University of Warsaw

Introduction: Liver transplantation remains the only therapeutic option for patients with end-stage liver disease. Progress in surgical technique, perioperative management and posttransplant immunosuppression over the last decades has led to major improvement of long-term survival. Aim of the study: was to analyze long-term results of liver transplantations with special focus on differences related to etiology of end-stage liver disease. Materials and methods: First 1000 consecutive liver transplantations performed in 944 patients between 1994 and 2011 in the Department of General, Transplant and Liver Surgery were included in this retrospective cohort study. There were 943 primary transplantations, 55 retransplantations and 2 second retransplantations. Patient and graft survival was estimated using Kaplan-Meier method and compared with log-rank tests. Results: Hepatitis C virus infection (27.8%), hepatitis B virus infection (18.0%) and alcoholic liver disease (17.7%) predominated among all causes of liver failure. Five-year overall (OS) and graft survival (GS) after primary transplantations was 74.3 and 71.0%, respectively. Retransplantations were associated with significantly decreased OS (54.7%; p=0.00001) and GS (52.9%; p=0.00005). Differences regarding survival outcomes between the patients after primary transplantations performed for hepatocellular carcinoma (5-year OS 56.0%; 5-year GS 53.0%), non-hepatocellular malignancies (OS 84.0%; GS 84.0%) and benign diseases (OS 75.5%; GS 72.2%) were non-significant (p=0.266 for OS; p=0.161 for GS). Considering all causes of liver failure, the patients with primary biliary cirrhosis demonstrated 5-year OS and GS superior to those transplanted for other benign indications. Significantly decreased survival rates were observed for patients undergoing liver transplantation for acute liver failure due to amanita phalloides intoxication and of undetermined etiology. Conclusions: Presented long-term results of liver transplantation are consistent with the reports from largest transplant centers worldwide. Excellent posttransplant survival rates may be expected in patients with primary biliary cirrhosis, whereas acute liver failure relates to poor outcomes