No Gains in Long-term Survival after Liver Transplantation over the Past Three Decades

Abbas Rana, Ruth L. Ackah, Gwilym J. Webb, Karim J. Halazun, John M. Vierling, Hao Liu, Meng Fen Wu, Dor Yoeli, Michael Kueht, Ayse L. Mindikoglu, Norman L. Sussman, Nhu T. Galván, Ronald T. Cotton, Christine A. O'Mahony, John A. Goss

Research output: Contribution to journalArticlepeer-review

85 Scopus citations


Objective: The aim of this study was to assess improvements in long-term survival after liver transplant by analyzing outcomes in transplant recipients who survived beyond 1 year. Summary of Background Data: Gains in short-term survival following liver transplantation have been gratifying. One-year survival in 1986 was 66% improved to over 92% in 2015. However, little is known about why long-term has not seen similar success. Methods: We analyzed 111,568 recipients from 1987 to 2016 using the Kaplan-Meier method for time-to-event analysis and multivariable Cox regression. Results: There were no significant gains in unadjusted long-term outcomes among 1-year survivors over the past 30 years. Only the time periods of 1987 to 1990 [hazard ratio (HR) 1.35, confidence interval CI) 1.28-1.42] and 1991 to 1995 (HR 1.17, CI 1.13-1.21) had a minor increase in risk compared with the period 2011 to 2016. Cause of death analysis suggests malignancy after transplantation is a growing problem and preventing recurrent hepatitis C with direct-acting antivirals (DDAs) may only have a limited impact. Furthermore, rejection leading to graft failure and death had a rare occurrence (1.7% of long-term deaths) especially when compared with the sequelae of long-term immunosuppression: malignancy (16.4%), nonrejection graft failure (9.8%), and infection (10.5%) (P < 0.001). Conclusion: In stark contrast to short-term survival, there have been no appreciable improvements in long-term survival following liver transplantation among 1-year survivors. Long-term sequelae of immunosuppression, including malignancy and infection, are the most common causes of death. This study highlights the need for better long-term immunosuppression management.

Original languageEnglish (US)
Pages (from-to)20-27
Number of pages8
JournalAnnals of surgery
Issue number1
StatePublished - Jan 1 2019
Externally publishedYes


  • chronic rejection
  • immunosuppression
  • liver transplantation
  • long-term survival

ASJC Scopus subject areas

  • Surgery


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