Outcomes after Liver Transplantation in Korea: Incidence and Risk Factors from Korean Transplantation Registry
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Background/Aims: To analyze the incidence and risk factors of outcomes after liver transplantation (LT) in the Korean population. Methods: This study analyzed data from the liver cohort of Korean Organ Transplantation Registry (KOTRY) who had LT between May 2014 and December 2017. Study measures included the incidence of post-LT outcomes in recipients of living donor LT (LDLT) and deceased donor LT (DDLT). Cox multivariate proportional hazards model was used to determine the potential risk factors predicting the outcomes. Results: A total of 2,563 adult recipients with LT (LDLT, n=1,956; DDLT, n=607) were included, with mean±standard deviation age of 53.9±8.9 years, and 72.2% were male. The post-LT outcomes observed in each LDLT and DDLT recipients were death (4.0% and 14.7%), graft loss (5.0% and 16.1%), rejection (7.0% and 12.0%), renal failure (2.7% and 13.8%), new onset of diabetes (12.5% and 15.4%), and hepatocellular carcinoma (HCC) recurrence (both 6.7%). In both LDLT and DDLT recipients, the most common post-LT complications were renal dysfunction (33.6% and 51.4%), infection (26.7% and 48.4%), and surgical complication (22.5% and 23.9%). Incidence of these outcomes were generally higher among recipients of DDLT than LDLT. Multivariate analysis indicated recipient age and DDLT as significant risk factors associated with death and graft loss. DDLT and ABO incompatible transplant were prognostic factors for rejection, and HCC beyond Milan criteria at pre-transplant was a strong predictor of HCC recurrence. Conclusions: This study is a good indicator of the post-LT prognosis in the Korean population and suggests a significant burden of post-LT complications.
Abstract
Background/Aims: To analyze the incidence and risk factors of outcomes after liver transplantation (LT) in the Korean population. Methods: This study analyzed data from the liver cohort of Korean Organ Transplantation Registry (KOTRY) who had LT between May 2014 and December 2017. Study measures included the incidence of post-LT outcomes in recipients of living donor LT (LDLT) and deceased donor LT (DDLT). Cox multivariate proportional hazards model was used to determine the potential risk factors predicting the outcomes. Results: A total of 2,563 adult recipients with LT (LDLT, n=1,956; DDLT, n=607) were included, with mean±standard deviation age of 53.9±8.9 years, and 72.2% were male. The post-LT outcomes observed in each LDLT and DDLT recipients were death (4.0% and 14.7%), graft loss (5.0% and 16.1%), rejection (7.0% and 12.0%), renal failure (2.7% and 13.8%), new onset of diabetes (12.5% and 15.4%), and hepatocellular carcinoma (HCC) recurrence (both 6.7%). In both LDLT and DDLT recipients, the most common post-LT complications were renal dysfunction (33.6% and 51.4%), infection (26.7% and 48.4%), and surgical complication (22.5% and 23.9%). Incidence of these outcomes were generally higher among recipients of DDLT than LDLT. Multivariate analysis indicated recipient age and DDLT as significant risk factors associated with death and graft loss. DDLT and ABO incompatible transplant were prognostic factors for rejection, and HCC beyond Milan criteria at pre-transplant was a strong predictor of HCC recurrence. Conclusions: This study is a good indicator of the post-LT prognosis in the Korean population and suggests a significant burden of post-LT complications.
참고문헌 (41)
- Wong MCS, "The changing epidemiology of liver diseases in the Asia-Pacific region", Nat Rev Gastroenterol Hepatol, 16, pp.57~73 (2019)
- "Causes of death statistics in 2017"[URL]
- Lee SG, "Liver transplantation in Korea : past, present, and future", Transplant Proc, 47, pp.705~708 (2015)
- Lee JG, "Donor safety in living donor liver transplantation : the Korean organ transplantation registry study", Liver Transpl, 23, pp.999~1006 (2017)
- Park GC, "A review of current status of living donor liver transplantation", Hepatobiliary Surg Nutr, 5, pp.107~117 (2016)
- "Organ transplantation statistics" (2019)[URL]
- Moreno R, "Post-liver transplantation medical complications", Ann Hepatol, 5, pp.77~85 (2006)
- Adam R, "Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry(ELTR)", J Hepatol, 57, pp.675~688 (2012)
- Bachir NM, "Adult liver transplantation in the United States", Am J Med Sci, 343, pp.462~469 (2012)
- Durand F, "How to improve long-term outcome after liver transplantation", Liver Int, 38(Suppl 1), pp.134~138 (2018)
- Durand F, "Age and liver transplantation", J Hepatol, 70, pp.745~758 (2019)
- Sarkar M, "Outcomes in liver transplantation : does sex matter?", J Hepatol, 62, pp.946~955 (2015)
- Yang J, "Design and methods of the Korean Organ Transplantation Registry", Transplant Direct, 3, pp.e191~ (2017)
- Lee J, "Development of a Korean liver allocation system using model for end stage liver disease scores : a nationwide, multicenter study", Sci Rep, 9, pp.7495~ (2019)
- Gil E, "Recipient age and mortality after liver transplantation : a population-based cohort study", Transplantation, 102, pp.2025~2032 (2018)
- Humar A, "Adult living donor versus deceased donor liver transplant(LDLT versus DDLT)at a single center : time to change our paradigm for liver transplant", Ann Surg, 270, pp.444~451 (2019)
- Azzam A, "Risk factors of hepatic graft failure, morbidity and mortality after living donor liver transplantation(LDLT) : review article", Clin Res Trials, 4, pp.1~11 (2018)
- Zhu B, "Living or deceased organ donors in liver transplantation for hepatocellular carcinoma: a systematic review and meta-analysis", HPB(Oxford), 21, pp.133~147 (2019)
- Jadlowiec CC, "Liver transplantation : current status and challenges", World J Gastroenterol, 22, pp.4438~4445 (2016)
- Yoon YI, "Living donor liver transplantation for hepatocellular carcinoma : an Asian perspective", Dig Dis Sci, 64, pp.993~1000 (2019)
- Bäckman L, "Causes of late graft loss after liver transplantation", Transplantation, 55, pp.1078~1082 (1993)
- Olthoff KM, "Outcomes of adult living donor liver transplantation : comparison of the adult-to-adult living donor liver transplantation cohort study and the national experience", Liver Transpl, 17, pp.789~797 (2011)
- Gwiasda J, "Identifying independent risk factors for graft loss after primary liver transplantation", Langenbecks Arch Surg, 402, pp.757~766 (2017)
- Sharma R, "Surgical complications following liver transplantation in patients with portal vein thrombosis--a single-center perspective", J Gastrointest Surg, 14, pp.520~527 (2010)
- Sandhu L, "Living donor liver transplantation versus deceased donor liver transplantation for hepatocellular carcinoma : comparable survival and recurrence", Liver Transpl, 18, pp.315~322 (2012)
- Park HW, "De novo malignancies after liver transplantation : incidence comparison with the Korean cancer registry", Transplant Proc, 44, pp.802~805 (2012)
- Hong SK, "Living donor liver transplantation for hepatocellular carcinoma in Seoul National University", Hepatobiliary Surg Nutr, 5, pp.453~460 (2016)
- Lee S, "Liver transplantation for hepatocellular carcinoma : Korean experience", J Hepatobiliary Pancreat Sci, 17, pp.539~547 (2010)
- Bahirwani R, "Outcomes after liver transplantation : chronic kidney disease", Liver Transpl (2009)
- Wiesen P, "Incidence and risk factors for early renal dysfunction after liver transplantation", World J Transplant, 6, pp.220~232 (2016)
- Kim SG, "Incidence and risk factors of renal dysfunction after liver transplantation in Korea", Transplant Proc, 36, pp.2318~2320 (2004)
- Lee SK, "Early postoperative renal dysfunction in the adult living donor liver transplantation", Transplant Proc, 39, pp.1517~1519 (2007)
- Abdel-Khalek EE, "Renal dysfunction after living-donor liver transplantation : experience with 500 cases", J Transplant, 2018, pp.5910372~ (2018)
- Cabezuelo JB, "Risk factors of acute renal failure after liver transplantation", Kidney Int, 69, pp.1073~1080 (2006)
- Barreto AG, "Risk factors for acute kidney injury and 30-day mortality after liver transplantation", Ann Hepatol, 14, pp.688~694 (2015)
- Machicao VI, "Impact of implementation of the MELD scoring system on the prevalence and incidence of chronic renal disease following liver transplantation", Liver Transpl, 12, pp.754~761 (2006)
- Gonwa TA, "Renal replacement therapy and orthotopic liver transplantation : the role of continuous veno-venous hemodialysis", Transplantation, 71, pp.1424~1428 (2001)
- Weiner DE, "The relationship between nontraditional risk factors and outcomes in individuals with stage 3 to 4 CKD", Am J Kidney Dis, 51, pp.212~223 (2008)
- Heisel O, "New onset diabetes mellitus in patients receiving calcineurin inhibitors : a systematic review and meta-analysis", Am J Transplant, 4, pp.583~595 (2004)
- Man Kim J, "Newonset diabetes after adult liver transplantation in the Korean Organ Transplantation Registry(KOTRY)study", Hepatobiliary Surg Nutr, 9, pp.425~439 (2020)
- Bodzin AS, "Liver transplantation today : where we are now and where we are going", Liver Transpl, 24, pp.1470~1475 (2018)