Survival analysis of liver transplant patients in Canada 1997-2002.

UNLABELLED Liver transplantation is an important health care issue for Canadians. Very few studies have assessed survival and determinants of survival in liver transplant patients in Canada. METHODS We carried out an epidemiological analysis of 1 year survival and determinants of 1 year survival in liver transplant patients, using Canadian Organ Replacement Registry data (1997-2002). Survival curves were plotted by the Kaplan-Meier method. Cox proportional hazards analysis was applied to evaluate hazard ratios with different age groups, gender, ethnicity, blood groups, donor type, pretransplantation medical status, and HBV infection status. RESULTS A total of 1164 liver transplant patients were included in the analysis. One-year survival rate was 84.7%. Male recipients had a 21% higher risk of developing organ failure than females. Recipients over 60 years of age had a 5% lower survival probability in comparison with recipients below 20 years of age. Pacific Islanders and Aboriginals had 32% and 9% lower survival probabilities, respectively, in comparison with Caucasians. Type B blood recipients had a 12% higher survival probability, whereas type AB blood recipients had a 7% lower survival probability compared with type O blood recipients. Twenty-six live organ recipients had 40% higher survival probabilities than 1138 cadaveric organ recipients. Patients with fulminant hepatitis (status 3F) had the highest survival, while patients with fulminant failure in ICU with intubation/ventilation (status 4F) had the lowest survival. One hundred sixty-seven recipients with positive HBsAg antigen showed 10% lower survival probability than 997 cases with negative HBsAg antigen. CONCLUSION In Canada, the first year survival rate is about 85%, which is comparable with other industrialized countries. Type of donor organs and recipient gender, ethnicity, ABO blood group, pretransplantation medical status, and HBV infection status had significant affects on the recipient survival.

[1]  M. Tonelli,et al.  Death and renal transplantation among Aboriginal people undergoing dialysis , 2004, Canadian Medical Association Journal.

[2]  Steven R. Martin,et al.  The management of chronic viral hepatitis: A Canadian consensus conference 2004. , 2004, The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale.

[3]  K. Detre,et al.  An update on liver transplantation in the United States: recipient characteristics and outcome. , 1995, Clinical transplants.

[4]  J. Roberts,et al.  Long‐term complications of living donor liver transplantation , 2000, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[5]  W. Kim,et al.  Outcome of liver transplantation for hepatitis B in the United States , 2004, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[6]  K. Kaita,et al.  Epidemiological study of hepatitis B virus infection in Manitoba, Canada, 1992–2003 , 2005, European Journal of Clinical Microbiology and Infectious Diseases.

[7]  M. McBride,et al.  Liver transplantation in the United States: a report from the UNOS Liver Transplant Registry. , 1999, Clinical transplants.

[8]  A. Burroughs,et al.  Late hepatic artery thrombosis after orthotopic liver transplantation , 2003, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[9]  J. Hux,et al.  Markers of access to and quality of primary care for aboriginal people in Ontario, Canada. , 2003, American journal of public health.

[10]  S. Fan,et al.  Indications for liver transplantation in patients with chronic hepatitis B and C virus infection and hepatocellular carcinoma , 2000, Journal of gastroenterology and hepatology.

[11]  G. Gerken,et al.  Living donor liver transplantation for hepatocellular carcinoma: A single‐center preliminary report , 2006, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[12]  D. Samuel.  Management of hepatitis B in liver transplantation patients. , 2004, Seminars in liver disease.

[13]  K. Newbold.  Problems in Search of Solutions: Health and Canadian Aboriginals , 1998, Journal of Community Health.

[14]  M. Makuuchi,et al.  Advantage in using living donors with aberrant hepatic artery for partial liver graft arterialization1 , 2002, Transplantation.

[15]  J. Gornbein,et al.  New Era of Liver Transplantation for Hepatitis B: A 17-Year Single-Center Experience , 2002, Annals of surgery.

[16]  P. Keown,et al.  Experience of a Canadian multi-organ transplant service. , 1986, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[17]  H. Isoniemi,et al.  Risk factors predicting survival of liver transplantation. , 2005, Transplantation proceedings.

[18]  D. Samuel,et al.  Antibodies to hepatitis B surface antigen prevent viral reactivation in recipients of liver grafts from anti-HBC positive donors , 2002, Gut.

[19]  W Marsh,et al.  Long-Term Survival After Liver Transplantation in 4,000 Consecutive Patients at a Single Center , 2000, Annals of surgery.

[20]  L. Johnson,et al.  Role of gender and race mismatch and graft failure in patients undergoing liver transplantation , 2002, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[21]  G. Ercolani,et al.  Causes of early acute graft failure after liver transplantation: analysis of a 17‐year single‐centre experience , 2005, Clinical transplantation.

[22]  C. Scudamore,et al.  Late acute rejection after liver transplantation: The Western Canada experience , 2002, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[23]  D. Samuel,et al.  Aspects of hepatitis C virus infection relating to liver transplantation , 2006, European journal of gastroenterology & hepatology.

[24]  D. Quantz,et al.  Access and utilization of health services by British Columbia's rural Aboriginal population. , 2005, International journal of health care quality assurance incorporating Leadership in health services.

[25]  Paulo Fontes,et al.  MELD and prediction of post–liver transplantation survival , 2006, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[26]  E. Schiff,et al.  Outcomes in liver transplant recipients with hepatitis B virus: Resistance and recurrence patterns from a large transplant center over the last decade , 2004, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[27]  Yong-feng Liu,et al.  Liver transplantation for patients with viral hepatitis. , 2003, Hepatobiliary & pancreatic diseases international : HBPD INT.

[28]  Shu-sen Zheng,et al.  Hepatitis B virus reinfection after liver transplantation: related risk factors and perspective. , 2005, Hepatobiliary & pancreatic diseases international : HBPD INT.

[29]  L. Bolondi,et al.  Analysis of risk factors for tumor recurrence after liver transplantation for hepatocellular carcinoma: Key role of immunosuppression , 2005, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[30]  W. Marks,et al.  Organ donation and utilization in the United States, 2004 , 2005, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.