Evolution of causes and risk factors for mortality post-liver transplant: results of the NIDDK long-term follow-up study.
Evolution of causes and risk factors for mortality post-liver transplant: results of the NIDDK long-term follow-up study.
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DOI：
10.1111/j.1600-6143.2010.03126.x
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发表时间：
2010-06
期刊：
影响因子：
--
通讯作者：
Charlton MR
中科院分区：
文献类型：
--
作者：
Watt KD;Pedersen RA;Kremers WK;Heimbach JK;Charlton MR
Although mortality rates following liver transplantation (LT) are well described, there is a lack of detailed, prospective studies determining patterns of and risk factors for long term mortality. We analyzed the multi-center, prospectively obtained NIDDK Liver Transplantation Database of 798 transplant recipients from 1990–1994 (followup 2003). Overall, 327 recipients died. Causes of death >1 year: 28% hepatic, 22% malignancy, 11% cardiovascular, 9% infection, 6% renal failure. Renal related death increased dramatically over time. Risk factors for death >1 year (univariate): male gender, age/decade, pre-LT diabetes, post-LT diabetes, post-LT hypertension, post-LT renal insufficiency, retransplantation >1 year, pre-LT malignancy, alcoholic (ALD) disease and metabolic liver disease, with similar risks noted for death >5 years. Hepatitis C, retransplantation, post-LT diabetes, hypertension and renal insufficiency were significant risk factors for liver related death. Cardiac deaths associated with age, male gender, ALD, cryptogenic disease, pre-LT hypertension and post-LT renal insufficiency. In summary, the leading causes of late deaths after transplant were graft failure, malignancy, cardiovascular disease and renal failure. Older age, diabetes, and renal insufficiency identified patients at highest risk of poor survival overall. Diligent management of modifiable post-LT factors including diabetes, hypertension and renal insufficiency may impact long term mortality.
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