Long-term follow-up of the first 500 liver transplant recipients transplanted at the Institute for Clinical and Experimental Medicine in Prague
Authors:
Pavel Trunečka 1,3; Miloš Adamec 2; Julius Špičák 3; Eva Honsová 4; Eva Kieslichová 5; Věra Lánská 6; Jan Peregrin 7; Miloš Kučera 2; Libor Janoušek 2; Martin Oliverius 2; Pavel Drastich 3; Milan Ročeň 5; Roman Danč 5; Halima Gottfriedová 3; Soňa Fraňková 3; Jan Šperl 3; Eva Pokorná 1; Štefan Vítko 8; Jan Malý 9
Authors place of work:
Institut klinické a experimentální medicíny Praha, Transplantcentrum
1; Institut klinické a experimentální medicíny Praha, Klinika transplantační chirurgie
2; Institut klinické a experimentální medicíny Praha, Klinika hepatogastroenterologie
3; Institut klinické a experimentální medicíny Praha, Pracoviště klinické a transplantační patologie
4; Institut klinické a experimentální medicíny Praha, Klinika anesteziologie, resuscitace a intenzivní péče
5; Institut klinické a experimentální medicíny Praha, Úsek lékařské statistiky
6; Institut klinické a experimentální medicíny Praha, Základna radiodiagnostiky a intervenční radiologie
7; Institut klinické a experimentální medicíny Praha, Klinika nefrologie
8; Institut klinické a experimentální medicíny Praha
9
Published in the journal:
Čas. Lék. čes. 2011; 150: 60-67
Category:
Original Article
Summary
Background:
Between April 1995 and November 2005, 500 liver transplantations were performed in 476 patients of age from 3, till 70, at the Transplantation center of the Institute of Clinical and Experimental Medicine (IKEM) in Prague. The most common indications for liver transplantation were alcoholic liver cirrhosis (23%), hepatitis C cirrhosis (17%), and cholestatic cirrhosis (PBC and PSC, 9% each). Mean MELD score of recipients at the transplantation was 15–18 for each year of transplantation. Ten-years patient survival was 79.1 Ī 2.2%, and graft survival 74.1 Ī 2.1% respectively. Best patient and graft survival was achieved among patients transplanted for autoimmune liver diseases, the worst in group of patients with alcoholic cirrhosis. Malignancies were the most common cause of death during the period of follow-up (17 patients).
Methods and results:
Patients were followed longitudinally at the Department of hepatogastroenterology IKEM according to prospective protocol included protocol biopsies. Hypertension (in 71% of recipients), and overweight or obesity (in 56.3%), were the most prevalent medical complications among long-term survivors. Diabetes was found in 28.6%, of which 14.7% was de-nove diabetes after transplantation. Renal insufficiency (S-creatinin > 150 μmol/l) was present in 61 of 348 (17.6%) survivors. Out of these, 16 needed chronic hemodialysis, and 12 underwent kidney transplantation subsequently. Protocol biopsy at 5 years after transplantation was evaluated in a sample of 102 unselected liver transplant recipients. Normal liver was found in 4% of recipients, minor non-specific changes in 36% of them. Disease recurrence was present in all of 16 recipients transplanted for HCV cirrhosis, in one third of them graft cirrhosis was already present. Disease recurrence was found in patients transplanted for autoimmune disease frequently, PBC in 40%, PSC in 25%, and autoimmune hepatitis in 60% of recipients. Graft steatosis greater than 33% was present in 13% of recipients.
Conclusions:
Liver transplantation is highly effective method of treatment of end stage liver disease. Despite frequent medical complications, and disease recurrence on histological examination almost 80% of recipients transplanted in the liver transplantation program in IKEM survived more than 10 years after procedure. The survival achieved was far above that of the European liver transplant registry.
Key words:
liver transplantation, indications, immunosuppression, MELD score, patient survival, graft survival, protocol biopsy.
Zdroje
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