Analysis of causes of late mortality in liver transplant recipients

OBJECTIVE: To evaluate the cause of late mortality in liver transplant recipients, and to study the prevention and management of these complications. METHODS: Two thousand nine hundred and forty patients who underwent liver transplantation at University of Pittsburgh and survived more than 1 year between February 1981 and April 1998 were included in this study. Cause of death, and other relative factors were analyzed. RESULTS: The rate of death dramatically decreased from 20.4% to 1.9% during that 10 years (1981-1991). Eight hundred and seventeen patients who survived more than 1 year had died during the follow-up period. The causes of death were malignant tumor (20.7%), cardiovascular complication (11.4%), infection (11.3%), and respiratory system complications (9.4%). Following the change in the immunosuppression protocol (1981-1986 was cyclosporin-A, 1986-1990 was OKT3, 1991-1998 was FK506), the 1-year death rate, 5-year death rate, and 10-year death rate were constantly decreased postoperatively. Patients of 3-18-year old group had the lowest mortality rate, while that of 19-60-year old group had the highest mortality rate. The patients who received liver transplantation because hepatic carcinoma or fulminant hepatic failure had the highest mortality after the operation. Mortality of the patients who received liver transplantation because of alcoholic cirrhosis increased gradually year by year. CONCLUSION: Malignant tumor, cardiovascular complication, infection and respiratory system complications are the most common causes of late mortality after liver transplantation. Early diagnosis and treatment can improve the survival rate.