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‘ workplace:
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:
Čas. Lék. čes. 2011; 150: 60-67
Category:
Original Article
Overview
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.
Sources
1. Wiesner RH, Rakela J, Ishitani MB, Mullighan DC, Spivey JR, Steers JL, Krom RAF. Recent advances in liver transplantation. Mayo Clin Proc 2003; 78: 197–210.
2. Wat KDS. Obezity and metabolit complications of liver transplantation. Liver Transplant 2010; 16: S65–S71.
3. Trunečka P, Vítko Š, Adamec M, Špičák J, Kieslichová E, Peregrin J, Honsová E, Hačkajlo M, Filip K. Výsledky programu transplantace jater v IKEM za 10 let trvání. Folia Gastroenterologica et Hepatologica 2005; 3(Suppl 1): S13–S21.
4. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg C, DęAmico G, Dickson R Kim R. A model to predict survival in patients with end-stage liver disease. Hepatology 2001; 33: 464–470.
5. Ishak K, Baptista A, Bianchi L, Callea F, De GJ, Gudat F, et al. Histological grading and staging of chronic hepatitis. J Hepatol 1995; 22: 696–699.
6. Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, Ferrell LD, Liu YC, Torbenson MS, Unalp-Arida A, Yeh M, McCullough AJ, Sanyal AJ. Nonalcoholic Steatohepatitis Clinical Research Network. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005; 41(6): 1313–1321.
7. Demetris A, Adams D, Bellamy C, Blakolmer K, Clouston A, Dhillon AP, Fung J, Gouw A, Gustafsson B, Haga H, Harrison D, Hart J, Hubscher S, Jaffe R, Khettry U,Lassman C, Lewin K, Martinez O, Nakazawa Y, Neil D, Pappo O, Parizhskaya M,Randhawa P, Rasoul-Rockenschaub S, Reinholt F, Reynes M, Robert M, Tsamandas A, Wanless I, Wiesner R, Wernerson A, Wrba F, Wyatt J, Yamabe H. Update of the International Banff Schema for Liver Allograft Rejection: working recommendations for the histopathologic staging and reporting of chronic rejection. An International Panel. Hepatology 2000; 31(3): 792–799.
8. Adam R, McMaster P, O’Grady JG, Castaing D, Klempnauer JL, Jamieson N, Neuhaus P, Lerut J, Salizzoni M, Pollard S, Muhlbacher F, Rogiers X, Garcia Valdecasas JC, Berenguer J, Jaeck D, Moreno Gonzalez E; European Liver Transplant Association. Evolution of liver transplantation in Europe: report of the European Liver Transplant Registry. Liver Transpl 2003; 9(12): 1231–1243.
9. Carithers RL, Jr. Liver transplantation. AASLD practice guidelines. Liver Transplant 2000; 6: 122–125.
10. Jain A, Reyes J, Kashyap R, Dodson F, Demetris AJ, Ruppert K, Abu–Elmagd K, Marsh W, Madariga J, Mazariegos A, Geller D, Bonham A, Gayowski T, Cacciarelli T, Fontes P, Starzl TE, Fung JJ. Long-term survival after liver transplantation in 4,000 consecutive patients at a single center. Ann Surg 2000; 22: 490–500.
11. Rossetto A, Bitetto D, Bresadola V, Lorenzin D, Baccarani U, De Anna D, Bresadola F, Adani GL. Cardiovascular risk factors and immunosuppressive regimen after liver transplantation. Transplant Proc 2010; 42(7): 2576–2578.
12. Richards J, Gunson B, Johnson J, Neuberger J. Weight gain and obesity after liver transplantation. Transpl Int 2005; 18(4): 461–466.
13. Toniutto P, Fabris C, Avellini C, Minisini R, Bitetto D, Rossi E, Smirne C, Pirisi M. Excess body weight, liver steatosis, and early fibrosis progression due to hepatitis C recurrence after liver transplantation. World J Gastroenterol 2005; 11(38): 5944–5950.
14. Seo S, Maganti K, Khehra M, Ramsamooj R, Tsodikov A, Bowlus C, McVicar J, Zern M, Torok N. De novo nonalcoholic fatty liver disease after liver transplantation. Liver Transpl 2007; 13(6): 844–847.
15. Kuo HT, Sampaio MS, Ye X, Reddy P, Martin P, Bunnapradist S. Risk factors for new-onset diabetes mellitus in adult liver transplant recipients, an analysis of the Organ Procurement and Transplant Network/United Network for Organ Sharing database. Transplantation 2010; 89(9): 1134–1140.
16. Rodrigues-Luna H, Douglas DD. Natural history of hepatitis C following liver transplantation. Curr Opin Infect Dis 2004; 17: 363–371.
17. Gopal DV, Rabkin JM, Berk BS, Corless CL, CHou S, Olyaei A, et al. Treatment of progresive hepatitis C recurrence after liver transplantation with combination interferon plus ribavirin. Liver Transplant 2001; 7: 181–190.
18. Trunečka P. Probability of development of HCV related cirrhosis in liver allograft. Protocol biopsy based study. Abstract Gut 2003; 35(Suppl 2): A42.
19. Duclos-Vallee JC, Sebagh M. Recurrence of autoimmune disease, primary sclerosing cholangitis, primary biliary cirrhosis, and autoimmune hepatitis after liver transplantation. Liver Transpl 2009; 15(Suppl 2): S25–S34.
20. Kotlyar DS, Campbell MS, Reddy KR. Recurrence of diseases following orthotopic liver transplantation. Am J Gastroenterol 2006; 101: 1370–1378.
21. Banff Working Group. Liver Biopsy Interpretation for Causes of Late Liver Allograft Dysfunction. Hepatology 2006; 44: 489–501.
22. Ojo AO, Held PJ, Port FK, Wolfe RA, Leichtman AB, Young EW, et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med 2003; 349: 931–940.
23. Charlton MR, Wall WJ, Ojo AO, GinŹs P, Textor S, Shihab FS, Marotta P, Cantarovich M, Eason JD, Wiesner RH, Ramsay MA, Garcia-Valdecasas JC, Neuberger JM, Feng S, Davis CL, Gonwa TA; International Liver Transplantation Society Expert Panel. Report of the first international liver transplantation society expert panel consensus conference on renal insufficiency in liver transplantation. Liver Transpl 2009; 15(11): S1–S34.
24. Schück O, Gottfriedova H, Maly J, Jabor A, Stollova M, Bruzkova I, Skibova J, Ryska M, Spicak J, Trunecka P, Novakova J. Glomerular filtration rate assessment in individuals after orthotopic liver transplantation based on serum cystatin C levels. Liver Transpl 2002; 8(7): 594–599.
25. Špičák J, Ryska M, Trunečka P, Skála I, Stirand P, Bělina F, Šperl J, Hrnčárková H, Taimr P, Vítko S, Filip K. The role of ERCP in management of biliary complications after liver transplantation. Ann Transplant 2001; 6(2): 29–32.
Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental HygienistArticle was published in
Journal of Czech Physicians
Most read in this issue
- Acute liver failure: Present recommendations
- Hyperglycemia and its control in the critically ill patient
- Kidney transplantation at the Institute for Clinical and Experimental Medicine
- Eversion carotid endarterectomy: evaluation of results after changing the operation technique