Factors Influencing Survival in the First Year Post Liver Transplantation Among Iraqi Patients

Nawal Mahdi Alkhalidi; Ali Hasan Kadhim; Muntadher Abdulkareem Abdullah

doi:10.54133/ajms.v10i1.2606

Authors

Nawal Mahdi Alkhalidi Baghdad Gastroenterology and Hepatology Teaching Hospital, Baghdad, Iraq
Ali Hasan Kadhim Kerbala Gastroenterology and Hepatology Hospital, Kerbala, Iraq
Muntadher Abdulkareem Abdullah Department of Medicine, College of Medicine, University of Basrah, Basrah, Iraq; Basrah Gastroenterology and Hepatology Hospital, Basrah, Iraq https://orcid.org/0000-0002-8893-1920

DOI:

https://doi.org/10.54133/ajms.v10i1.2606

Keywords:

Liver transplantation, Mortality , Survival rate

Abstract

Background: Liver transplantation has transformed medicine, especially for patients with advanced liver disease and hepatocellular carcinoma, improving their lifespan and quality of life. Objective: To assess the one-year survival rate post-liver transplantation and analyze the factors influencing survival. Methods: A retrospective study conducted at Baghdad Gastroenterology Hospital analyzed data from liver transplant referrals over the last 5 years, based on the Model for End-Stage Liver Disease score. 100 patients were classified as children (≤18 years) and adults (≥19 years) and followed up for one year post-transplant. Mortality analysis considered various etiological, clinical, and sociodemographic factors. Results: In adults, males were predominant among both patients (66%) and donors (71.7%). The most frequent cause was cryptogenic cirrhosis (39.62%), then viral and autoimmune hepatitis (20.75% and 18.87%), respectively. Of the 53 adult patients, 5 died (9.43%), and 48 survived (90.57%). The age gap and BMI were significantly different. In pediatrics, biliary atresia was the most common cause (36.17%). Of the 47 pediatric patients, 16 died (34%) and 31 survived (66%). However, there were notable differences in the causes of liver cirrhosis between deceased and surviving patients. BMI and age gap between donors and recipients significantly affect survival in adults, while biliary atresia, Caroli disease, and hyperoxaluria have the highest one-year mortality in pediatric patients. Conclusions: Over 90% of adults and 66% of children survive a year after receiving a liver transplant; in adults, age and BMI differences have a major impact. In contrast, pediatric survival was affected by the etiology of cirrhosis.

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References

Craig EV, Heller MT. Complications of liver transplant. Abdom Radiol (NY). 2021;46(1):43-67. doi: 10.1007/s00261-019-02340-5. DOI: https://doi.org/10.1007/s00261-019-02340-5

Hart A, Lentine KL, Smith JM, Miller JM, Skeans MA, Prentice M, et al. OPTN/SRTR 2019 Annual data report: Kidney. Am J Transplant. 2021;21(Suppl 2):21-137. doi: 10.1111/ajt.16502. DOI: https://doi.org/10.1111/ajt.16502

Starzl TE, Marchioro TL, Porter KA, Brettschneider L. Homotransplantation of the liver. Transplantation. 1967;5(4):790-803. doi: 10.1097/00007890-196707001-00003. DOI: https://doi.org/10.1097/00007890-196707001-00003

Calne RY, Williams R, Dawson JL, Ansell ID, Evans DB, Flute PT, et al. Liver transplantation in man. II. A report of two orthotopic liver transplants in adult recipients. Br Med J. 1968;4:541-546. PMID: 4881064. DOI: https://doi.org/10.1136/bmj.4.5630.540

Adam R, Karam V, Delvart V, O’Grady J, Mirza D, Klempnauer J, et al. Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol. 2012 ;57:675-688. doi: 10.1016/j.jhep.2012.04.015. DOI: https://doi.org/10.1016/j.jhep.2012.04.015

Martin P, DiMartini A, Feng S, Brown R, Fallon M. Evaluation for liver transplantation in adults : 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology. 2014;59(3):1144-1165. doi: 10.1002/hep.26972. DOI: https://doi.org/10.1002/hep.26972

European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu. EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol. 2016;64(2):433-485. doi: 10.1016/j.jhep.2015.10.006. DOI: https://doi.org/10.1016/j.jhep.2015.10.006

Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003;124:91-96. doi: 10.1053/gast.2003.50016. DOI: https://doi.org/10.1053/gast.2003.50016

Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31:864-871. doi: 10.1053/he.2000.5852. DOI: https://doi.org/10.1053/he.2000.5852

Merion RM, Schaubel DE, Dykstra DM, Freeman RB, Port FK, Wolfe RA. The survival benefit of liver transplantation. Am J Transplant. 2005;5:307-313. doi: 10.1111/j.1600-6143.2004.00703.x. DOI: https://doi.org/10.1111/j.1600-6143.2004.00703.x

Habib S, Berk B, Chang CC, Demetris AJ, Fontes P, Dvorchik I, et al. MELD and prediction of post-liver transplantation survival. Liver Transpl. 2006;12:440-447. doi: 10.1002/lt.20721. DOI: https://doi.org/10.1002/lt.20721

Freeman RB, Gish RG, Harper A, Davis GL, Vierling J, Lieblein L, et al. Model for end-stage liver disease (MELD) exception guidelines: results and recommendations from the MELD Exception Study Group and Conference (MESSAGE) for the approval of patients who need liver transplantation with diseases not considered by the standard MELD formula. Liver Transpl. 2006;12:128-136. doi: 10.1002/lt.20979. DOI: https://doi.org/10.1002/lt.20979

John S, Thuluvath PJ. Hyponatremia in cirrhosis: pathophysiology and management. World J Gastroenterol. 2015;21(11):3197-3205. doi: 10.3748/wjg.v21.i11.3197. DOI: https://doi.org/10.3748/wjg.v21.i11.3197

Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359(10):1018-1026. doi: 10.1056/NEJMoa0801209. DOI: https://doi.org/10.1056/NEJMoa0801209

Londoño MC, Cárdenas A, Guevara M, Quintó L, de Las Heras D, Navasa M, et al. MELD score and serum sodium in the prediction of survival of patients with cirrhosis awaiting liver transplantation. Gut. 2007;56(9):1283-1290. doi: 10.1136/gut.2006.102764. DOI: https://doi.org/10.1136/gut.2006.102764

Kalra A, Wedd JP, Biggins SW. Changing prioritization for transplantation: MELD-Na, hepatocellular carcinoma exceptions, and more. Curr Opin Organ Transplant. 2016;21(2):120-126. doi: 10.1097/MOT.0000000000000281. DOI: https://doi.org/10.1097/MOT.0000000000000281

Ryckman FC, Alonso MH, Bucuvalas JC, Balistreri WF. Long-term survival after liver transplantation. J Pediatr Surg. 1999;34(5):845-850. doi: 10.1016/s0022-3468(99)90385-8. DOI: https://doi.org/10.1016/S0022-3468(99)90385-8

Keswani RN, Ahmed A, Keeffe EB. Older age and liver transplantation: a review. Liver Transpl. 2004;10:957-967. doi: 10.1002/lt.20155. DOI: https://doi.org/10.1002/lt.20155

Kuramitsu K, Egawa H, Keeffe EB, Kasahara M, Ito T, Sakamoto S, et al. Impact of age older than 60 years in living donor liver transplantation. Transplantation. 2007;84:166-172. doi: 10.1097/01.tp.0000269103.87633.06. DOI: https://doi.org/10.1097/01.tp.0000269103.87633.06

Aranzana EM, Coppini AZ, Ribeiro MA, Massarollo PC, Szutan LA, Ferreira FG. Model for end-stage liver disease, model for liver transplantation survival and donor risk index as predictive models of survival after liver transplantation in 1,006 patients. Clinics (Sao Paulo). 2015;70(6):413-418. doi: 10.6061/clinics/2015(06)05. DOI: https://doi.org/10.6061/clinics/2015(06)05

Zaydfudim V, Feurer ID, Moore DE, Wisawatapnimit P, Wright JK, Wright Pinson C. The negative effect of pretransplant overweight and obesity on the rate of improvement in physical quality of life after liver transplantation. Surgery. 2009;146(2):174-180. doi: 10.1016/j.surg.2009.04.027. PMID: 19628071. DOI: https://doi.org/10.1016/j.surg.2009.04.027

Saab S, Lalezari D, Pruthi P, Alper T, Tong MJ. The impact of obesity on patient survival in liver transplant recipients: a meta-analysis. Liver Int. 2015;35(1):164-170. doi: 10.1111/liv.12431. DOI: https://doi.org/10.1111/liv.12431

Nair S, Verma S, Thuluvath PJ. Obesity and its effect on survival in patients undergoing orthotopic liver transplantation in the United States. Hepatology. 2002;35(1):105-109. doi: 10.1053/jhep.2002.30318. DOI: https://doi.org/10.1053/jhep.2002.30318

Akarsu M, Bakir Y, Karademir S, Unek T, Bacakoglu A, Astarcioglu I. Prevalence and risk factors for obesity after liver transplantation: a single-center experience. Hepat Mon. 2013;13(8):e7569. doi: 10.5812/hepatmon.7569. DOI: https://doi.org/10.5812/hepatmon.7569

Lai Q, Giovanardi F, Melandro F, Larghi Laureiro Z, Merli M, Lattanzi B ,et al. Donor-to-recipient gender match in liver transplantation: A systematic review and meta-analysis. World J Gastroenterol. 2018;24(20):2203-2210. doi: 10.3748/wjg.v24.i20.2203. DOI: https://doi.org/10.3748/wjg.v24.i20.2203

Weismüller TJ, Prokein J, Becker T, Barg-Hock H, Klempnauer J, Manns MP, et al. Prediction of survival after liver transplantation by pre-transplant parameters. Scand J Gastroenterol. 2008;43(6):736-746. doi: 10.1080/00365520801932944. DOI: https://doi.org/10.1080/00365520801932944

Snyder A, Kojima L, Imaoka Y, Akabane M, Kwong A, Melcher ML, et al. Evaluating the outcomes of donor-recipient age differences in young adults undergoing liver transplantation. Liver Transpl. 2023;29(8):793-803. doi: 10.1097/LVT.0000000000000109. DOI: https://doi.org/10.1097/LVT.0000000000000109

Zhang XM, Fan H, Wu Q, Zhang XX, Lang R, He Q. In-hospital mortality of liver transplantation and risk factors: a single-center experience. Ann Transl Med. 2021;9(5):369. doi: 10.21037/atm-20-5618. DOI: https://doi.org/10.21037/atm-20-5618

Lehner F, Becker T, Klempnauer J, Borlak J. Gender-incompatible liver transplantation is not a risk factor for patient survival. Liver Int. 2009;(2):196-202. doi: 10.1111/j.1478-3231.2008.01827.x. DOI: https://doi.org/10.1111/j.1478-3231.2008.01827.x

Germani G, Zeni N, Zanetto A, Adam R, Karam V, Belli LS, et al. Influence of donor and recipient gender on liver transplantation outcomes in Europe. Liver Int. 2020;40(8):1961-1971. doi: 10.1111/liv.14510. DOI: https://doi.org/10.1111/liv.14510

van Son J, Stam SP, Gomes-Neto AW, Osté MCJ, Blokzijl H, van den Berg AP, et al. Post-transplant obesity impacts long-term survival after liver transplantation. Metabolism. 2020;106:154204. doi: 10.1016/j.metabol.2020.154204. DOI: https://doi.org/10.1016/j.metabol.2020.154204

Takagi K, de Wilde RF, Polak WG, IJzermans JNM. The effect of donor body mass index on graft function in liver transplantation: A systematic review. Transplant Rev (Orlando). 2020;34(4):100571. doi: 10.1016/j.trre.2020.100571. DOI: https://doi.org/10.1016/j.trre.2020.100571

Molina Raya A, Vílchez Rabelo A, Domínguez Bastante M, Fundora Suarez Y. Influence of donor obesity on long-term liver transplantation outcomes. Transplant Proc. 2019;51(1):62-66. doi: 10.1016/j.transproceed.2018.03.134. DOI: https://doi.org/10.1016/j.transproceed.2018.03.134

Nagler E, Van Vlierberghe H, Colle I, Troisi R, de Hemptinne B. Impact of MELD on short-term and long-term outcome following liver transplantation: a European perspective. Eur J Gastroenterol Hepatol. 2005;17(8):849-856. doi: 10.1097/00042737-200508000-00012. DOI: https://doi.org/10.1097/00042737-200508000-00012

Saab S, Wang V, Ibrahim AB, Durazo F, Han S, Farmer DG, et al. MELD score predicts 1-year patient survival post-orthotopic liver transplantation. Liver Transpl. 2003;9(5):473-476. doi: 10.1053/jlts.2003.50090. DOI: https://doi.org/10.1053/jlts.2003.50090

Vogt DP, Henderson JM, Carey WD, Barnes D. The long-term survival and causes of death in patients who survive at least 1 year after liver transplantation. Surgery. 2002;132(4):775-780. doi: 10.1067/MSY.2002.128343. DOI: https://doi.org/10.1067/msy.2002.128343

Jain A, Reyes J, Kashyap R, Dodson SF, Demetris AJ, Ruppert K, et al. Long-term survival after liver transplantation in 4,000 consecutive patients at a single center. Ann Surg. 2000;232(4):490-500. doi: 10.1097/00000658-200010000-00004. DOI: https://doi.org/10.1097/00000658-200010000-00004

Ryckman FC, Alonso MH, Bucuvalas JC, Balistreri WF. Biliary atresia--surgical management and treatment options as they relate to outcome. Liver Transpl Surg. 1998;4(5 Suppl 1):S24-S33. PMID: 9742491.

Keeling S, McDonald MF, Anand A, Dunson J, Williams E, Zhang T, et al. Recipient age predicts 20-year survival in pediatric liver transplant. Can J Gastroenterol Hepatol. 2022;2022:1466602. doi: 10.1155/2022/1466602. DOI: https://doi.org/10.1155/2022/1466602

Zhang Y. Impact of donor recipient gender and race mismatch on graft outcomes in patients with end-stage liver disease undergoing liver transplantation. Prog Transplant. 2017;27(1):39-47. doi: 10.1177/1526924816679839. DOI: https://doi.org/10.1177/1526924816679839

Perito ER, Rhee S, Glidden D, Roberts JP, Rosenthal P. Impact of the donor body mass index on the survival of pediatric liver transplant recipients and post-transplant obesity. Liver Transpl. 2012;18(8):930-939. doi: 10.1002/lt.23438. DOI: https://doi.org/10.1002/lt.23438

Oya F, Akın A, Mehmet EA, Zafer G, Umut A, Özlem Y, et al. Scoring systems and postoperative outcomes in pediatric liver transplantation. Transpl Proc. 2019;51(7):2430-2433. doi: 10.1016/j.transproceed.2019.01.174. DOI: https://doi.org/10.1016/j.transproceed.2019.01.174

Barshes NR, Lee TC, Udell IW, O’Mahoney CA, Karpen SJ, Carter BA, et al. The pediatric end-stage liver disease (PELD) model as a predictor of survival benefit and posttransplant survival in pediatric liver transplant recipients. Liver Transpl. 2006;12:475-480. doi: 10.1002/lt.20703. DOI: https://doi.org/10.1002/lt.20703

Alex G.C, Heung B.K, Khashayar V.Pediatric liver transplantation. Semin Pediatric Surg. 2017;26(4):217-223.doi: 10.1053/j.sempedsurg.2017.07.014. DOI: https://doi.org/10.1053/j.sempedsurg.2017.07.014

Jain A, Mazariegos G, Kashyap R, Kosmach-Park B, Starzl TE, Fung J, et al. Pediatric liver transplantation: A single center experience spanning 20 years. Transplantation. 2002;73(6):941-947. doi: 10.1097/00007890-200203270-00020. DOI: https://doi.org/10.1097/00007890-200203270-00020

Stey AM, Doucette J, Florman S, Emre S. Donor and recipient factors predicting time to graft failure following orthotopic liver transplantation: a transplant risk index. Transplant Proc. 2013;45(6):2077-2082. doi: 10.1016/j.transproceed.2013.06.001. DOI: https://doi.org/10.1016/j.transproceed.2013.06.001

Roberts MS, Angus DC, Bryce CL, Valenta Z, Weissfeld L. Survival after liver transplantation in the United States: a disease-specific analysis of the UNOS database. Liver Transpl. 2004;10(7):886-897. doi: 10.1002/lt.20137. DOI: https://doi.org/10.1002/lt.20137