Medical epidemiology of patients surviving ten years after liver transplantation

Simo KA, Sereika S, Bitner N, Newton KN, Gerber DA. Medical epidemiology of patients surviving ten years after liver transplantation.
Clin Transplant 2011: 25: 360–367. © 2010 John Wiley & Sons A/S. Abstract: The transition into extended long‐term follow‐up after liver transplantation raises a new series of issues with respect to continuing care of this population. A retrospective study was performed, analyzing patients who underwent orthotopic liver transplant (OLT) and survived ≥10 yr at a single institution. Long‐term comorbidities such as diabetes mellitus (DM), hypertension (HTN), chronic kidney disease (CKD), coronary artery disease (CAD), and obesity were identified and standardized prevalence ratios ([SPR]) utilized to compare with the general US population. There was an increased prevalence of HTN ([SPR] = 2.25 ± 0.61), DM ([SPR] = 2.67 ± 0.72), and CKD ([SPR] = 15.3 ± 4.04) but not CAD or obesity. In multivariate analysis, non‐viral etiology of end‐stage liver disease was associated with CKD (OR 3.42 CI 1.11–10.53), and an initial glomerular filtration rate (GFR) <60 mL/min per 1.73 m² (CKD stages III–V) was associated with HTN (OR 4.62 CI 1.14–18.73) after OLT. Creatinine ≥1.5 mg/dL at 10 yr was associated with an initial GFR <60 mL/min per 1.73 m² (p = 0.000) and CAD after OLT (p = 0.012). Patients, 10 yr after OLT, have a significantly higher prevalence of HTN, DM, and CKD than the general population, which is not confounded by obesity. Increased vigilance and proactive management are required to further improve long‐term outcomes.