Evolution Of The Results Of 1500 Liver Transplantations Performed In The Department Of General, Transplant And Liver Surgery Medical University Of Warsaw

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Liver transplantation is a well-established treatment of patients with end-stage liver disease and selected liver tumors. Remarkable progress has been made over the last years concerning nearly all of its aspects.

The aim of this study was to evaluate the evolution of long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery (Medical University of Warsaw).

Material and methods. Data of 1500 liver transplantations performed between 1989 and 2014 were retrospectively analyzed. Transplantations were divided into 3 groups: group 1 including first 500 operations, group 2 including subsequent 500, and group 3 comprising the most recent 500. Five year overall and graft survival were set as outcome measures.

Results. Increased number of transplantations performed at the site was associated with increased age of the recipients (p<0.001) and donors (p<0.001), increased rate of male recipients (p<0.001), and increased rate of piggyback operations (p<0.001), and decreased MELD (p<0.001), as well as decreased blood (p=0.006) and plasma (p<0.001) transfusions. Overall survival was 71.6% at 5 years in group 1, 74.5% at 5 years in group 2, and 85% at 2.9 years in group 3 (p=0.008). Improvement of overall survival was particularly observed for primary transplantations (p=0.004). Increased graft survival rates did not reach the level of significance (p=0.136).

Conclusions. Long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery are comparable to those achieved in the largest transplant centers worldwide and are continuously improving despite increasing recipient age and wider utilization of organs procured from older donors.

1. Krawczyk M, Grąt M, Barski K et al.: Analysis of long-term outcomes after liver transplantation in the Department of General, Transplant and Liver Surgery at the Medical University of Warsaw. Gastroenterol Pol 2012; 19: 43-50.

2. Singal AK, Guturu P, Hmoud B et al.: Evolving frequency and outcomes of liver transplantation based on etiology of liver disease. Transplantation 2013; 95: 755-60.

3. Curry MP, Forns X, Chung RT et al.: Sofosbuvir and ribavirin prevent recurrence of HCV infection after liver transplantation: an open-label study. Gastroenterology 2015; 148: 100-07.

4. Grąt M, Kornasiewicz O, Hołówko W et al.: Evaluation of total tumor volume and pretransplantationα-fetoprotein level as selection criteria for liver transplantation in patients with hepatocellular cancer. Transplant Proc 2013; 45: 1899-1903.

5. Grąt M, Kornasiewicz O, Lewandowski Z et al.: Combination of morphologic criteria and α-fetoprotein in selection of patients with hepatocellular carcinoma for liver transplantation minimizes the problem of posttransplant tumor recurrence. World J Surg 2014; 38: 2698-2707.

6. Krawczyk M, Grzelak I, Zieniewicz K et al.: The impact of experience of a transplantation center on the outcomes of orthotopic liver transplantation. Transplant Proc 2003; 35: 2268-70.

7. Dane Centrum Organizacyjno-Koordynacyjnego do spraw transplantacji „Poltransplant”, http://www.poltransplant.org.pl/(stan na 31.01.2015)

8. Krawczyk M, Grąt M, Barski K et al.: 1000 liver transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw – analysis of indications and results. Pol Przegl Chir 2012; 84: 304-12.

9. Nijboer A, Ulrich F, Bechstein WO et al.: Volume and outcome relation in German liver transplant centers: what lessons can be learned?Transplant Res 2014; 3: 5.

10. Ozhathil DK, Li YF, Smith JK et al.: Impact of center volume on outcomes of increased-risk liver transplants. Liver Transpl 2011; 17: 1191-99.

11. Washburn WK, Meo NA, Halff GA et al.: Factors influencing liver transplant length of stay at two large-volume transplant centers. Liver Transpl 2009; 15: 1570-78.

12. Macomber CW, Shaw JJ, Santry H et al.: Centre volume and resource consumption in liver transplantation. HPB (Oxford) 2012; 14: 554-59.

13. Edwards EB, Roberts JP, McBride MA et al.: The effect of the volume of procedures at transplantation centers on mortality after liver transplantation. N Engl J Med 1999; 341: 2049-53.

14. Ozhathil DK, Li Y, Smith JK et al.: Effect of centre volume and high donor risk index on liver allograft survival. HPB (Oxford) 2011; 13: 447-53.

15. Reichert B, Kaltenborn A, Becker T et al.: Massive blood transfusion after the first cut in liver transplantation predicts renal outcome and survival. Langenbecks Arch Surg 2014; 399: 429-40.

16. Rana A, Petrowsky H, Hong JC et al.: Blood transfusion requirement during liver transplantation is an important risk factor for mortality. J Am Coll Surg 2013; 216: 902-07.

17. Grąt M, Kornasiewicz O, Lewandowski Z et al.: The impact of surgical technique on the results of liver transplantation in patients with hepato cellular carcinoma. Ann Transplant 2013; 18: 448-59.

18. Grąt M, Kornasiewicz O, Grąt K et al.: Short and long-term outcomes after primary liver transplantation in elderly patients. Pol Przegl Chir 2013; 85: 581-88.

19. Yi SH, Yi HM, Fu BS et al.: Long-term results of liver transplantation for over 60 years old patients with hepatitis B virus-related end-stage liver disease. Hepatobiliary Pancreat Dis Int 2014; 13: 501-07.

20. Wilson GC, Quillin RC 3rd, Wima K et al.: Is liver transplantation safe and effective in elderly (≥70 years) recipients? A case-controlled analysis. HPB (Oxford) 2014; 16: 1088-94.

21. Reese PP, Yeh H, Thomasson AM et al.: Transplant center volume and outcomes after liver retransplantation. Am J Transplant 2009; 9: 309-17.

22. Wong RJ, Chou C, Bonham CA et al.: Improved survival outcomes in patients with non-alcoholic steatohepatitis and alcoholic liver disease following liver transplantation: an analysis of 2002-2012 United Network for Organ Sharing data. Clin Transplant 2014; 28: 713-21.

23. Krawczyk M, Grąt M, Kornasiewicz O et al.: Results of liver transplantation in the Department of General, Transplant and Liver Surgery at the Medical University of Warsaw in patients with chronic hepatitis B and C viruses infection. Przegl Epidemiol 2013; 67: 5-10, 93-07.

24. Grąt M, Kornasiewicz O, Lewandowski Z et al.: Post-transplant outcomes of patients with and without hepatitis C virus infection according to donor age and gender matching. Ann Transplant 2013; 18: 705-15.

25. Koljonen V, Fredrik A, Aki R et al.: Self-Reported Alcohol Use and Depressive Symptoms After Liver Transplantation.Transplantation 2014 (w druku).

26. Grąt M, Lewandowski Z, Grąt K et al.: Negative outcomes after liver transplantation in patients with alcoholic liver disease beyond the fifth post-transplant year. Clin Transplant 2014; 28: 1112-20.

27. Nyckowski P, Dudek K, Skwarek A et al.: Results of liver transplantation according to indications for orthotopic liver transplantation. Transplant Proc 2003; 35: 2265-07.

28. Nguyen GC, Thuluvath NP, Segev DL et al.: Volumes of liver transplant and partial hepatectomy procedures are independently associated with lower postoperative mortality following resection for hepatocellular carcinoma. Liver Transpl 2009; 15: 776-81.

29. Grąt M, Hołówko W, Grzegorczyk K et al.: Longterm results of liver resection in the treatment of patients with hepatocellular carcinoma. Pol Przegl Chir 2011; 83: 319-24.

30. Grąt M, Grzegorczyk K, Lewandowski Z et al.: Intraoperative injuries during liver resection: analysis of 1,005 procedures. Hepatol Int 2012; 6: 498-504.

Polish Journal of Surgery

The Journal of Foundation of the Polish Journal of Surgery

Journal Information

CiteScore 2016: 0.29

SCImago Journal Rank (SJR) 2016: 0.166
Source Normalized Impact per Paper (SNIP) 2016: 0.207


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