LONG-TERM OUTCOMES OF DECEASED DONOR LIVER TRANSPLANTATION

Aim of the study was to evaluate patient and graft survival after liver transplantation (LT) and to determine if primary disease diagnosis, early graft dysfunction or other factors affect it. Furthermore, we analyzed the reasons
of short-term and long-term deaths or retransplantations.

Materials and methods. 192 LTs from donors with brain death were performed from December 2004 until June 2014. Recipient age varied from 5 to 71 years. Most frequent diagnosis was liver cirrhosis (mainly due to hepatitis C), then hepatocellular carcinoma (HCC), liver graft dysfunction, etc.

Results and discussion. 1-year patient survival is 89.5%, graft survival is 87.7%, 3-year –87% and 84.6%, respectively, and 5-year – 83.5% and 83.0%, respectively. Early mortality (in fi rst 30 days after transplantation) was 8%, long-term mortality – 5.9%. Primary non-function graft (PNF) was the reason of 66.7% early deaths. In the long term, infections and oncology were the reasons of death with the same frequency – 36.4%. Early graft dysfunction including primary non-function signifi cantly decreases short term survival (p = 0.0002). Nevertheless, in the majority of cases graft function improves and doesn’t affect survival. Donor factors play role in outcomes: early dysfunction is higher (40.6%) in extended criteria donor group than in standard donor group (р = 0.0431). PNF has the same trend – 8.5% and 0.0%, respectively, but without signifi cance (р =0.0835). 5-year survival is remarkably lower in HCC group 40.8% (p = 0.003) than in other groups.

Conclusion: survival after liver transplantation in our Center is comparable with the results of the world’s centers.

1. Готье СВ, Мойсюк ЯГ, Хомяков СМ. Донорство и трансплантация органов в Российской Федерации в 2013 году. VI сообщение регистра Российского трансплантологического общества. Вестник трансплантологии и искусственных органов. 2014; 2: 5–23. Gautier SV, Moĭ syuk YaG, Khomyakov SM. Donorstvo i transplantatsiya organov v Rossiĭ skoĭ Federatsii v 2013 godu. VI soobshchenie registra Rossiĭ skogo transplantologicheskogo obshchestva. Vestnik transplantologii i iskusstvennykh organov = Russian Journal of Transplantology and Artifi cial Organs. 2014; 2: 5–23.

2. Чжао АВ. Трансплантация печени в НИИ скорой помощи им. Н.В. Склифосовского. Трансплантология. 2011; 1: 65–67. Chzhao AV. Transplantatsiya pecheni v NII skoroĭ pomoshchi im. N.V. Sklifosovskogo. Transplantologiya. 2011; 1: 65–67.

3. Готье СВ, Мой сюк ЯГ, Попцов ВН, Корнилов МН, Цирульникова ОМ, Ярошенко ЕБ и др. Опыт 100 трансплантаций трупной печени в одном центре. Вестник трансплантологии и искусственных органов. 2012; 1: 6–15. Gautier SV, Moĭ syuk YaG, Poptsov VN, Kornilov MN, Tsirul'nikova OM, Yaroshenko EB et al. Opyt 100 transplantatsiĭ trupnoĭ pecheni v odnom tsentre. Vestnik transplantologii i iskusstvennykh organov = Russian Journal of Transplantology and Artifi cial Organs. 2012; 1: 6–15.

4. Гранов АМ, Гранов ДА, Жеребцов ФК, Герасимова ОА, Боровик ВВ, Осовских ВВ и др. Трансплантация печени в РНЦРХТ. Опыт 100 операций. Вестник трансплантологии и искусственных органов. 2012; 4: 11–16. Granov AM, Granov DA, Zherebtsov FK, Gerasimova OA, Borovik VV, Osovskikh VV et al. Transplantatsiya pecheni v RNTsRKhT. Opyt 100 operatsiĭ. Vestnik transplantologii i iskusstvennykh organov = Russian Journal of Transplantology and Artifi cial Organs. 2012; 4: 11–16.

5. Olthoff KM, Kulik L, Samstein B, Kaminski M, Abecassis M, Emond J et al. Validation of a current defi nition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl. 2010; 16 (8): 943–949.

6. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996; 334 (11): 693–699.

7. Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001; 33 (6): 1394–1403.

8. Хубутия МШ, Коваленко ЮА, Чугунов АО, Чжао АВ, Джаграев КР, Салиеенко АА и др. Отдаленные результаты трансплантации печени при гепатоцеллюлярном раке. Трансплантология. 2012; 3: 6–15. Khubutiya MSh, Kovalenko YuA, Chugunov AO, Chzhao AV, Dzhagraev KR, Salieenko AA et al. Otdalennye rezul'taty transplantatsii pecheni pri gepatotsellyulyarnom rake. Transplantologiya. 2012; 3: 6–15.

9. Berenguer M. Viral hepatitis after liver transplantation. Hepatol Res. 2007 Sep; 37 (2): S279–286.

10. Гранов ДА, Боровик ВВ, Жеребцов ФК, Полысалов ВН, Майстренко ДН, Руткин ИО и др. Ретрансплантация печени: опыт российского научного центра радиологии и хирургических технологий (РНЦРХТ). Вестник трансплантологии и искусственных органов. 2011; 4: 43–47. Granov DA, Borovik VV, Zherebtsov FK, Polysalov VN, Maĭ strenko DN, Rutkin IO et al. Retransplanta tsiya pecheni: opyt rossiĭ skogo nauchnogo tsentra radiologii i khirurgicheskikh tekhnologiĭ (RNTsRKhT). Vestnik transplantologii i iskusstvennykh organov = Russian Journal of Transplantology and Artifi cial Organs. 2011; 4: 43–47.

11. Busuttil RW, Farmer DG, Yersiz H, Hiatt JR, McDiarmid SV, Goldstein LI et al. Analysis of long-term outcomes of 3200 liver transplantations over two decades: a single-center experience. Ann Surg. 2005 Jun; 241 (6): 905–916; discussion 916–918.

12. http://www.eltr.org/spip.php?rubrique37.

13. http://srtr.transplant.hrsa.gov/archives.aspx.