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The Evolution of Liver Transplantation During 3 Decades: Analysis of 5347 Consecutive Liver Transplants at a Single Center

Agopian, Vatche G. MD*; Petrowsky, Henrik MD*; Kaldas, Fady M. MD*; Zarrinpar, Ali MD, PhD*; Farmer, Douglas G. MD*; Yersiz, Hasan MD*; Holt, Curtis PharmD*; Harlander-Locke, Michael BS*; Hong, Johnny C. MD*; Rana, Abbas R. MD*; Venick, Robert MD; McDiarmid, Sue V. MD; Goldstein, Leonard I. MD; Durazo, Francisco MD; Saab, Sammy MD; Han, Steven MD; Xia, Victor MD§; Hiatt, Jonathan R. MD; Busuttil, Ronald W. MD, PhD, FACS*

doi: 10.1097/SLA.0b013e3182a15db4
Papers of the 133rd ASA Annual Meeting

Objective: To analyze a 28-year single-center experience with orthotopic liver transplantation (OLT) for patients with irreversible liver failure.

Background: The implementation of the model for end-stage liver disease (MELD) in 2002 represented a fundamental shift in liver donor allocation to recipients with the highest acuity, raising concerns about posttransplant outcome and morbidity.

Methods: Outcomes and factors affecting survival were analyzed in 5347 consecutive OLTs performed in 3752 adults and 822 children between 1984 and 2012, including comparisons of recipient and donor characteristics, graft and patient outcomes, and postoperative morbidity before (n = 3218) and after (n = 2129) implementation of the MELD allocation system. Independent predictors of survival were identified.

Results: Overall, 1-, 5-, 10-, and 20-year patient and graft survival estimates were 82%, 70%, 63%, 52%, and 73%, 61%, 54%, 43%, respectively. Recipient survival was best in children with biliary atresia and worst in adults with malignancy. Post-MELD era recipients were older (54 vs 49, P < 0.001), more likely to be hospitalized (50% vs 47%, P = 0.026) and receiving pretransplant renal replacement therapy (34% vs 12%, P < 0.001), and had significantly greater laboratory MELD scores (28 vs 19, P < 0.001), longer wait-list times (270 days vs 186 days, P < 0.001), and pretransplant hospital stays (10 days vs 8 days, P < 0.001). Despite increased acuity, post-MELD era recipients achieved superior 1-, 5-, and 10-year patient survival (82%, 70%, and 65% vs 77%, 66%, and 58%, P < 0.001) and graft survival (78%, 66%, and 61% vs 69%, 58%, and 51%, P < 0.001) compared with pre-MELD recipients. Of 17 recipient and donor variables, era of transplantation, etiology of liver disease, recipient and donor age, prior transplantation, MELD score, hospitalization at time of OLT, and cold and warm ischemia time were independent predictors of survival.

Conclusions: We present the world's largest reported single-institution experience with OLT. Despite increasing acuity in post-MELD era recipients, patient and graft survival continues to improve, justifying the “sickest first” allocation approach.

Outcomes and factors affecting survival were analyzed in 5347 consecutive liver transplants at a single center over 28 years, including comparisons before and after implementation of the model for end-stage liver disease (MELD) allocation system in 2002. Despite increasing recipient acuity in the post-MELD era, graft and patient survival continue to improve.

*Department of Surgery, Dumont-UCLA Transplant and Liver Cancer Centers, Pfleger Liver Institute, Los Angeles, CA; and

Departments of Pediatrics,

Medicine,

§Anesthesiology, and

Division of General Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA.

Reprints: Ronald W. Busuttil, MD, PhD, FACS, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, University of California, 10833 Le Conte Ave, Room 77-120 CHS, Box 957054, Los Angeles, CA 90095.; E-mail: rbusuttil@mednet.ucla.edu.

Disclosure: The authors declare no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins.