Immunosuppression, cancer, and the long-term outcomes after liver transplantation: Can we do better?

✍ Scribed by James M. Abraham; Julie A. Thompson

• Publisher: John Wiley and Sons
• Year: 2010
• Tongue: English
• Weight: 66 KB
• Volume: 16
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.22114

✦ Synopsis

Most of the focus of orthotopic liver transplantation (OLT) research, since its inception as a treatment for end-stage liver disease in 1968, has been on factors that influence short-term outcomes (specifically acute cellular rejection). Five-year survival after transplantation improved to 72% from 59% in one center between 1981 and 1998; 10-year survival improved to 60% from 52% in the same center. 1 These improvements can be attributed to a number of factors: better risk stratification of OLT candidates and perioperative care after transplant (infectious prophylaxis, management of surgical complications, among others), as well as improved understanding and application of immunosuppression. 1 Although early survival after OLT has improved significantly, the factors which influence the long-term outcomes, ie, survival at >10 years after OLT, are less well-defined and studied.

A growing body of evidence on factors influencing the long-term outcomes after OLT bears a common theme. As patients who undergo OLT live longer, common causes of mortality in the general population become increasingly important, such as cardiovascular disease, diabetes mellitus, chronic kidney disease, and malignancy. Although early threats to survival have been positively affected by improvements in immunosuppression, improved immunosuppression could have a negative effect on long-term outcomes. Indeed, the incidence of cardiovascular disease, diabetes mellitus, chronic kidney disease, and malig-