Reuters Health Information (2012-05-23): Liver transplant outcomes improving in Europe
Liver transplant outcomes improving in Europe
Last Updated: 2012-05-23 10:00:23 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Outcomes of liver transplantation for acute liver failure (ALF) in Europe have improved over two decades, according to a report online April 18th in the Journal of Hepatology.
And Dr. Andrew K. Burroughs, the senior author of the report, told Reuters Health by email that "results are improving despite poorer quality of donors, so this is a major achievement in the transplantation field."
Dr. Burroughs of University College London and colleagues analyzed donor, graft and recipient variables from the European Liver Transplant Registry database on 4,903 adults transplanted between 1988 and 2009.
For example, one-, three-, and five-year patient survival rates were 66%, 62%, and 61%, respectively, from 1988 to 1993, 75%, 72% and 70% from 1999 to 2003, and 79%, 75% and 72% between 2004 and 2009.
Patient survival rates in that most recent period were significantly better than in 1999-2003 (p=0.01), 1994-1998 (p=0.001), and 1988-1993 (p<0.001).
There were similar findings for graft survival. One-, three-, and five-year graft survival rates were only 51%, 47%, and 45%, respectively, from 1988 to 1993. By 2004 to 2009, those rates were 73%, 68%, and 63%, respectively.
The improved results from 2004 to 2009 were particularly noteworthy as the proportions of donors older than 60 rose from 1.8% in 1988-1993 to 21% most recently.
The authors also found that transplants for acute liver failure due to acetaminophen overdose increased seven-fold over the study period, from 2% to 14.1%. Close to 8% of these patients died or lost their grafts chiefly because of suicide or non-adherence to immunosuppressive medications. More than half of these events were in the first year.
Factors associated with poor outcomes included acetaminophen-related acute liver failure (relative risk 1.24), reduced-size grafts (RR, 1.43), recipient age above 50 (RR, 1.26) and ABO-incompatible grafts (RR, 2.04).
In prognostic models constructed by the authors, recipients older than 50 years who received grafts from donors older than 60 years would have 57% mortality/graft loss within the first year.
Dr. Burroughs added that despite the overall improvement, "there may be a group of patients whose characteristics make them unlikely to survive with a poorer quality donor and this may influence practice."
J Hepatol 2012.