Buescher N, Seehofer D, Helbig M, Andreou A, Bahra M, Pascher A, Pratschke J, Schoening W. Evaluating twenty-years of follow-up after orthotopic liver transplantation, best practice for donor-recipient matching: What can we learn from the past era? World J Transplant 2016; 6(3): 599-607 [PMID: 27683639 DOI: 10.5500/wjt.v6.i3.599]
Corresponding Author of This Article
Dr. Wenzel Schoening, Department of General, Visceral and Transplantation Surgery, University Hospital, Universitätsklinikum der RWTH Aachen, 52074 Aachen, Germany. wschoening@ukaachen.de
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Sep 24, 2016; 6(3): 599-607 Published online Sep 24, 2016. doi: 10.5500/wjt.v6.i3.599
Evaluating twenty-years of follow-up after orthotopic liver transplantation, best practice for donor-recipient matching: What can we learn from the past era?
Niklas Buescher, Daniel Seehofer, Michael Helbig, Andreas Andreou, Marcus Bahra, Andreas Pascher, Johann Pratschke, Wenzel Schoening
Niklas Buescher, Daniel Seehofer, Michael Helbig, Andreas Andreou, Marcus Bahra, Andreas Pascher, Johann Pratschke, Wenzel Schoening, Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow Klinikum, 13465 Berlin, Germany
Wenzel Schoening, Department of General, Visceral and Transplantation Surgery, University Hospital, 52074 Aachen, Germany
Author contributions: Buescher N collected and analyzed data and wrote and revised paper; Seehofer D designed research, analyzed data and revised paper; Helbig M collected and analyzed data; Andreou A analyzed data and revised paper; Bahra M revised paper; Pascher A revised paper; Pratschke J revised paper; Schoening W designed research, analyzed data, wrote and revised paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Charité, University Hospital, Campus Virchow Klinikum, Berlin, Germany.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Wenzel Schoening, Department of General, Visceral and Transplantation Surgery, University Hospital, Universitätsklinikum der RWTH Aachen, 52074 Aachen, Germany. wschoening@ukaachen.de
Telephone: +49-241-8089501 Fax: +49-241-8082417
Received: March 13, 2016 Peer-review started: March 17, 2016 First decision: April 18, 2016 Revised: July 4, 2016 Accepted: July 29, 2016 Article in press: August 1, 2016 Published online: September 24, 2016 Processing time: 192 Days and 4.6 Hours
Abstract
AIM
To characterize major determinants of 20-year survival after liver transplantation (LT).
METHODS
This longitudinal single-institution study includes 313 consecutive patients who received a LT between 1988 and 1992. Pretransplant clinical characteristics and laboratory values were assessed and compared between 20-year survivors and non-survivors. Particular attention was paid to the Model for End-Stage Liver Disease (labMELD)-score and the Eurotransplant Donor Risk Index (ET-DRI) to unravel their impact on 20-year survival after LT.
RESULTS
Twenty-year survivors were significantly younger (44 vs 50 years, P = 0.001), more likely to be female (49% vs 36%, P = 0.03) and less likely to be obese at the time of LT (19% vs 32%, P = 0.011). Mean labMELD-score (P = 0.156), rate of high-urgency LT (P = 0.210), cold-ischemia time (P = 0.994), rate of retransplantation (P = 0.12) and average donor age (28 vs 33 years, P = 0.099) were not statistically different. The mean estimated glomerular filtration rate was higher among survivors (P = 0.007). ET-DRI > 1.4 (P = 0.020) and donor age ≥ 30 years (P < 0.022) had significant influence on 20-year survival. The overall survival was not significantly impacted by labMELD-score categories (P = 0.263).
CONCLUSION
LT offers excellent long-term results in case of optimal donor and recipient conditions. However, mainly due to the current organ shortage, these ideal circumstances are rarely given; thus algorithms for donor-recipient matching need to be refined, in order to enable a maximum benefit for the recipients of high quality as well as marginal organs.
Core tip: We compare characteristics of 20-year survivors and non-survivors after liver transplantation. The lab model for end-stage liver disease-score seems not to be an adequate tool for predicting long-term (20 years) outcome. The Eurotransplant Donor Risk Index (ET-DRI) has a significant impact on long-term survival. While close to 60% of patients that received a donor organ with an ET-DRI < 1.2 survived for 20 years and longer, only less than 40% of the patients with an ET-DRI > 1.4 survived the same number of years. Only about 20% survivors had overweight before transplantation, compared to about 33% non-survivors. The mean estimated glomerular filtration rate was higher among survivors.
