Thirty Years and Beyond: Long-term Outcomes After Liver Transplantation at a Single Center: Progress, Challenges, and Future Implications.
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BACKGROUND: The liver transplantation (LT) program was established at Hannover Medical School in 1972. The aim of the study was to assess graft and patient survival, organ function, and active life throughout ≥3 decades after LT, with a special focus on recipients surviving ≥30 y after transplantation. METHODS: Clinical data from all consecutive patients undergoing LT between 1972 and 1994 were collected in a prospective design, and outcome data were complemented retrospectively. RESULTS: Nine hundred LTs performed on 756 patients were included in the study. Survival increased with growing experience during the study period. One hundred thirty-eight patients survived ≥30 y, of whom 35 (25%) received >1 graft. Chronic kidney disease was observed in 96 recipients (70%), necessitating additional kidney transplants in 16 patients (12%). De novo malignancy was diagnosed in 31 patients (23%; 4% after pediatric and 33% after adult LT, P < 0.001) during the long-term follow-up. The leading cause of death beyond a 30-y survival was cardiovascular. Twenty-seven patients (38%) had a child after LT; 33 pediatric transplant recipients (89%) engaged in professional employment posttransplant. CONCLUSIONS: This is the first study offering detailed insight into LT survival beyond 30 y. The data show that 30-y survival after LT is reachable in relevant numbers, with stable graft function and the opportunity to live an active, self-directed life.