Evaluating twenty-years of follow-up after orthotopic liver transplantation, best practice for donor-recipient matching: What can we learn from the past era?

Table 1 Indications of primary liver transplant

	All patients n = 313 (100%)	20-yr survivors n = 157 (50%)	20-yr non- survivors n = 141 (45%)	Ratio1	Lost n = 15 (5%)
Virus-related cirrhosis	92 (29.4%)	46 (29.30%)	39 (27.70%)	1.18	7
Hepatitis B	47 (15.0%)	26 (16.6%)	19 (13.5%)
Hepatitis C	32 (10.2%)	13 (8.3%)	17 (12.1%)
Hepatitis B and D	10 (3.2%)	5 (3.2%)	2 (1.4%)
Hepatitis B and C	3 (1.0%)	2 (1.3%)	1 (0.7%)
Cholestatic/ autoimmune	64 (20.4%)	38 (24.2%)	20 (14.2%)	1.90	6
Alcoholic cirrhosis	50 (16.0%)	23 (14.6%)	27 (19.1%)	0.85
Hepatobiliary malignancy	36 (11.5%)	7 (4.5%)	28 (19.9%)	0.25	1
HCC	27 (8.6%)	6 (3.8%)	20 (14.2%)
CCC	5 (1.6%)	0 (0.0%)	5 (3.5%)
Klatskin tumor	4 (1.3%)	1 (0.6%)	3 (2.1%)
Cryptogenic cirrhosis	29 (9.3%)	15 (9.6%)	13 (9.2%)	1.15	1
Acute liver failure	23 (7.3%)	16 (10.2%)	7 (5.0%)	2.29
Others	19 (6.1%)	13 (8.3%)	6 (4.3%)	2.20

¹ratio of survivors/non-survivors in the respective indication category. HCC: Hepatocellular carcinomas; CCC: Cholangiocellular carcinoma.

Table 2 Pretransplant characteristics

	All patients n = 313	20-yr-survivors n = 157	20-yr-non-survivors n = 141	P
Recipients
Age (yr)	47 (14-66)	44 (14-66)	50 (25-65)	0.001
Age < 18, n (%)	2 (0.6)	2 (1.3)	0 (0)	0.06
Age > 55, n (%)	57 (18)	19 (12)	36 (26)	0.03
Gender, n (%) female	135 (43)	77 (49)	51 (36)	0.03
labMELD-score	18.6 (± 7.6)	19.4 (± 8.3)	18.1 (± 7.0)	0.156
Urgent LT, n (%)	23 (7)	15 (10)	8 (6)	0.21
BMI (kg/m2)	23.0 ± 3.3	22.7 ± 3.0	23.5 ± 3.7	0.037
HBMI, n (%)	78 (25%)	30 (19%)	45 (32%)	0.011
HLIP, n (%)	45 (14%)	20 (15%)	23 (19%)	0.376
Donors
Donor age (yr)	30 (9-64)	28 (14-64)	33 (9-60)	0.099
ET-DRI	1.35 (± 0.2)	1.32 (± 0.2)	1.37 (± 0.2)	0.121
Transplant
Cold ischemia time, h	10.6 (± 4)	10.6 (± 4)	10.7 (± 4)	0.994
Retransplantation, n (%)	46 (15)	18 (11)	25 (18)	0.120
Liver function
tBili	8.1 ± 11.9	9.0 ± 12.6	7.7 ± 11.6	0.363
AST	115 ± 460	124 ± 486	111 ± 454	0.820
ALT	102 ± 233	102 ± 177	108 ± 286	0.849
INR	1.76 ± 0.8	1.82 ± 0.8	1.7 ± 0.8	0.226
Clinical characteristics
Systolic BP (mmHg)	120 ± 20	119 ± 20	122 ± 21	0.340
Diastolic BP (mmHg)	71 ± 11	71 ± 12	72 ± 11	0.353
Laboratory parameters
Glucose (mg/dL)	120 ± 58	116 ± 46	126 ± 70	0.174
Cholesterol (mg/dL)	134 ± 72	129 ± 55	138 ± 86	0.311
Triglycerides (mg/dL)	95 ± 67	91 ± 56	100 ± 80	0.326
Creatinine (mg/dL)	1.0 ± 0.8	1.06 ± 1.0	0.95 ± 0.4	0.247
eGFR (mL/min per 1.73 m2)	98 ± 59	106 ± 70	88 ± 39	0.007

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; HLIP: Hyperlipidemia; HBMI: Overweight; MELD: Model for end-stage liver disease; ET-DRI: Eurotransplant donor-risk-index; INR: International normalized ratio.

Table 3 Pretransplant renal function n (%)

	20-yr survivors n = 155	20-yr non-survivors n = 140	P
eGFR > 60	126 (80%)	112 (79%)	0.860
MIRF	31 (20%)	29 (21%)	0.879
SIRF	7 (4.5%)	4 (2.9%)	0.453
eGFR 30-39	10 (6.5%)	5 (3.6%)	0.261
eGFR 40-49	8 (5.2%)	7 (5.0%)	0.950
eGFR 50-59	8 (5.2%)	13 (9.3%)	0.169
eGFR 60-69	10 (6.5%)	28 (20%)	0.001
eGFR 70-79	10 (6.5%)	22 (15.7%)	0.011
eGFR 80-89	22 (14.2%)	13 (9.3%)	0.193
eGFR 90-99	16 (10.3%)	14 (10.0%)	0.927
eGFR 100-109	15 (9.7%)	9 (6.4%)	0.308
eGFR 110-119	10 (6.5%)	7 (5.0%)	0.593
eGFR > 120	47 (30.3%)	28 (20.0%)	0.042

LT: Liver transplantation; eGFR: Estimated glomerular filtration rate; MIRF: Moderately impaired renal function; SIRF: Severely impaired renal function.