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The Evolution of Liver Transplantation during Three Decades: Analysis of 5347 Consecutive Liver Transplants at a Single Center
Vatche G Agopian*, Henrik Petrowsky*, Ali Zarrinpar*, Fady M Kaldas*, Douglas G Farmer, Johnny C Hong*, Michael Harlander-Locke*, Curtis Holt*, Francisco Durazo*, Sammy Saab*, Steven Han*, Leonard I Goldstein*, Hasan Yersiz*, Jonathan R Hiatt, Ronald W Busuttil
University of California, Los Angeles, Los Angeles, CA

Objective: To analyze a 28-year single-center experience with liver transplantation (LT), the standard of care for patients with irreversible liver failure.
Methods: Outcomes and factors affecting survival were analyzed in 5347 consecutive LTs performed in 3752 adults and 822 children between 1984 and 2012, including comparisons before (n=3218) and after (n=2129) implementation of the Model for End-Stage Liver Disease (MELD) allocation system in 2002.
Results: Overall 1-, 5-, 10-, and 20-year patient and graft survival estimates were 82%, 70%, 63%, 52% and 73%, 61%, 54%, 43%, respectively. Recipient survival was best in children with biliary atresia and worst in adults with malignancy. Post-MELD era recipients were older, more likely hospitalized, and had greater MELD scores, longer waitlist times and pre- and post-transplant hospital stays. Despite increased acuity, post-MELD era graft and patient survival improved significantly, with shorter cold and warm ischemia times and less frequent early retransplantation (Table 1, Figure). Multivariate predictors of overall patient survival included era of transplantation, recipient and donor age, liver disease, retransplantation, and ischemia times.
Conclusions: We report the world’s largest single-institution experience with LT. Despite increasing acuity in post-MELD era recipients, graft and patient survival continue to improve, justifying the “sickest first” allocation approach.
Table 1
Pre-MELD (n=3218)Post-MELD (n=2129)P-value
Recipient age (yrs)4954<0.0001
Hospitalization (%)47500.026
Average MELD score2030<0.0001
Time from listing to LT (days)186270<0.0001
Pre-transplant LOS (days)810<0.0001
Post-transplant LOS (days)2934<0.0001
Cold ischemia time (min)441406<0.0001
Warm ischemia time (min)4741<0.0001
Retransplantation < 30 days (%)9.44.1<0.0001


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