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 hun- dred 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 cardiovascu- lar 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 espe- cially of malignant tumours in this long-term follow-up study indi- cate that further optimization and especially minimization of immunosuppressive therapy as well as development of newer ther- apies in order to prevent recurrent allograft diseases are the pri- ority for the future development of transplant medicine. (Acta gastroenterol. belg., 2005, 68, 323-330).