Sobrevivência a Longo Prazo após Transplante Ortotópico de Fígado: Análise de 20 anos em um Centro de Transplante em Campinas, Brasil

Victor Kenzo Ivano; Rafaela Hamada Jucá; Arthur Nunes Martins Neto; Fernanda Kreve; Tiago Diniz; Alexandre Foratto; Derli Conceição Munhoz; Eduardo Riccetto; Caique Fernandes Alves; Simone Reges Perales; Elaine Cristina Ataide; Ilka de Fátima Santana F. Boin

Authors

Victor Kenzo Ivano Universidade Estadual de Campinas – Faculdade de Ciências Médicas – Departamento de Transplante de Fígado – Campinas/SP – Brazil. https://orcid.org/0000-0003-0160-2372
Rafaela Hamada Jucá Universidade Estadual de Campinas – Faculdade de Ciências Médicas – Departamento de Transplante de Fígado – Campinas/SP – Brazil. https://orcid.org/0009-0002-6391-4363
Arthur Nunes Martins Neto Universidade Estadual de Campinas – Faculdade de Ciências Médicas – Departamento de Transplante de Fígado – Campinas/SP – Brazil. https://orcid.org/0009-0007-2562-4302
Fernanda Kreve Universidade Estadual de Campinas – Faculdade de Ciências Médicas – Departamento de Transplante de Fígado – Campinas/SP – Brazil. https://orcid.org/0000-0002-0676-7865
Tiago Diniz Universidade Estadual de Campinas – Faculdade de Ciências Médicas – Departamento de Transplante de Fígado – Campinas/SP – Brazil. https://orcid.org/0000-0003-1470-6058
Alexandre Foratto Universidade Estadual de Campinas – Faculdade de Ciências Médicas – Departamento de Transplante de Fígado – Campinas/SP – Brazil. https://orcid.org/0000-0002-1839-2511
Derli Conceição Munhoz Universidade Estadual de Campinas – Faculdade de Ciências Médicas – Departamento de Transplante de Fígado – Campinas/SP – Brazl. https://orcid.org/0000-0003-4272-9847
Eduardo Riccetto Universidade Estadual de Campinas – Faculdade de Ciências Médicas – Departamento de Transplante de Fígado – Campinas/SP – Brazil. https://orcid.org/0000-0002-1137-8709
Caique Fernandes Alves Universidade Estadual de Campinas – Faculdade de Ciências Médicas – Departamento de Transplante de Fígado – Campinas/SP – Brazil. https://orcid.org/0000-0002-4341-3214
Simone Reges Perales State University of Campinas (UNICAMP) https://orcid.org/0000-0003-2263-9254
Elaine Cristina Ataide Universidade Estadual de Campinas – Faculdade de Ciências Médicas – Departamento de Transplante de Fígado – Campinas/SP – Brazil. https://orcid.org/0000-0002-2672-7326
Ilka de Fátima Santana F. Boin Universidade Estadual de Campinas – Faculdade de Ciências Médicas – Departamento de Transplante de Fígado – Campinas/SP – Brazil. https://orcid.org/0000-0002-1165-2149

Keywords:

Liver Transplantation, Survivorship, Hepatic Insufficiency, Chronic Liver Disease, Hospital Mortality, Prognostic Factors

Abstract

Introduction: Orthotopic liver transplantation (OLT) is the primary therapy for end-stage liver disease. In Brazil, the number of liver transplants has significantly increased over the past decades, improving long-term outcomes. This study analyzes the long-term survival of patients who underwent OLT over 20 years at a reference transplant center. Methods: Medical records of 848 patients who underwent OLT between February 1995 and December 2017 were reviewed. Exclusion criteria included patients with survival below six months to minimize the impact of early postoperative complications on long-term outcomes. Thus, 174 patients were included. The analyzed variables involved the recipient, donor, graft, surgical procedure, and postoperative evolution. Survival was assessed using Kaplan–Meier analysis. Results: Among the 174 analyzed patients, 98 (56.3%) remained in outpatient follow-up, while 76 (43.7%) died. The mean age at transplantation was 47 years, and 75% of recipients were male. The main indications were viral hepatitis (59.8%) and hepatocellular carcinoma (11.6%). The mean MELD score was 18. The leading cause of death was cardiovascular events (36.4%), followed by liver disease recurrence (22.1%) and malignancies (15.6%). The mean survival time was 223 months for surviving patients and 112 months for deceased patients (p 0.0001). Longer cold ischemia time, postoperative renal dysfunction, diabetes, and prolonged stay in the intensive care unit were associated with worse survival. Younger patients had significantly longer survival (p = 0.00007). Conclusion: The 20-year analysis demonstrated that OLT provides good long-term survival; however, factors such as diabetes, renal dysfunction, and prolonged cold ischemia time negatively impact the outcomes. Cardiovascular events and recurrence of liver disease were the leading causes of mortality.

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References

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Long-Term Survival after Orthotopic Liver Transplant: 20-year analysis at a Transplant Center in Campinas, Brazil

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