Long-term medical complications and quality of life in adult recipients surviving 10 years or more after liver transplantation.

BACKGROUND AND STUDY AIMS

Little information is available about long-term results after adult liver transplantation. This study analyses long-term medical complications, changes of immunosuppression, recurrence of primary disease and quality of life 10 years after liver transplantation.

MATERIAL AND METHODS

During the period February 1984-April 1994, 324 LT were performed in 282 adults (>15 years). One hundred forty-seven (52%) patients survived more than 10 years. Data regarding health status of 103 patients exclusively followed-up in our institution were analyzed.

RESULTS

Actual 1, 5, 10 years survival rates of the 282 recipients were 76.6%, 64.9% and 52% respectively. Forty eight (46.6%) of the 103 studied patients had normal liver tests in their tenth year of the follow-up. Seventy-one (69%) patients were on a CyA, TAC or MMF monotherapy; 31 (30%) patients had CyA levels of less than 100ng/ml. Forty five patients had recurrent allograft disease. Twenty-four (40.6%) of 59 liver biopsy available at 10th year were normal. Thirty five (34%) patients developed chronic renal failure; nine (8.7%) of them had end-stage renal disease. New onset hypertension (>140/100 mmHg) developed in 49 (47.6%) patients; fourteen (13.6%) developed diabetes (glucose blood level > 140 mg/dl) and twenty five (24.2%) patients had serious cardiovascular events. Thirteen (12.6%) patients had a BMI>28 and thirty six (35%) patients had elevated serum cholesterol (>220 mg/dl). Cataract was present in 8 (7.7%) patients. De novo malignancy developed in 23 (22.3%) patients. One patient each developed nasopharyngeal lymphoproliferative disease and myeloma. Quality of life of this patient cohort was excellent as shown by a Karnofsky score of more than 80% in 96.6% of patients.

CONCLUSION

The high rate of medical complications and especially of malignant tumours in this long-term follow-up study indicate that further optimization and especially minimization of immunosuppressive therapy as well as development of newer therapies in order to prevent recurrent allograft diseases are the priority for the future development of transplant medicine.