Liver

There has been a steady improvement in both short- and long-term graft survival in deceased liver donor transplant recipients since 1991, despite a corresponding increase in the severity of liver disease in transplant recipients as reflected by an in increase in the Mayo End Stage Liver Disease Score (MELD). For patients who underwent liver transplant in the US from 2008-2010, the overall 5-year survival rate was 73.6% (Kim et al., 2017). Graft survival in transplant recipients from living donors has also improved in the short- and long-term since 1999.

Graft failure among adult deceased-donor liver transplant recipients (upper graph) and living-donor liver transplant recipients (lower graph) are shown in the figures below (Kim et al., 2017).

Graft failure among adult deceased (upper graph) and living donor (lower graph) liver transplant recipients (including multi-organ transplants). Note the difference in scales on the x axis.
Graft failure among adult deceased (upper graph) and living donor (lower graph) liver transplant recipients (including multi-organ transplants). Note the difference in scales on the x axis.

Figure 7: Graft failure among adult deceased (upper graph) and living donor (lower graph) liver transplant recipients (including multi-organ transplants). Note the difference in scales on the x axis. Estimates were computed with Cox proportional hazards models adjusted for age, sex, and race (Kim et al., 2017).

Other than allograft-related, complications in liver transplant recipients include obesity, metabolic syndrome, cardiovascular disease, renal dysfunction, and malignancies which contribute towards morbidity and mortality (Singh and Watt, 2012; 2014). Approximately two thirds of deaths after the first-year post liver transplantation are unrelated to graft dysfunction. Recurrence of hepatitis C virus infection contributes to long-term morbidity and mortality and additionally patients transplanted for hepatitis C virus infection have an increased incidence of acute cellular rejection leading to reduced patient and graft survival (Charlton, 2014). The introduction of new anti-viral agents (Curry et al., 2015; Zhang, 2016) should improve outcomes for patients transplanted for HCV disease. However, recent advances in direct-acting antivirals (DAAs) for HCV may revolutionise the need for liver transplant in this setting. With the latest HCV DAAs offering response rates >90%, a reduction in the incidence of liver cirrhosis, liver decompensation and HCC can be expected. Furthermore, improvements in liver function following viral eradication should enable a significant number of HCV patients to be removed from liver transplant waiting lists with projections expecting an adequate liver transplantation supply for nearly all patients with HCC in future. Advances in HCV treatment may not only reduce the number of patients requiring a liver transplantation but may increase the number of donors available with HCV-positive donors being reconsidered. With the new DAAs, transmission of HCV to the donor recipient should be curable and recent data suggests that liver transplant outcomes are comparable between patients who received HCV-positive and HCV-negative grafts (Ponziani et al., 2017).