{
  "abstract": "Background Liver transplantation (LT) is a life-saving intervention for patients with selected hepatic malignancies, acute liver failure and end-stage liver disease. While short-term outcomes following LT have improved significantly, long-term survival remains a challenge. This study aimed to investigate the causes of delayed mortality post-LT.Methods We performed a retrospective analysis of all adult liver transplants performed at a single UK centre between October 1988 and June 2024. Data collected included LT indication, donor and recipient details, date and cause of death (COD). COD was analysed by timepoint (<1 year, 1–5 years, 5–10 years, >10 years post-LT) and by LT indication.Results During the study period, 2587 LTs were performed. 1000 deaths were recorded. Detail on COD was unavailable in 121 of cases (12.1%). 1-year mortality was 12.9% (334/2587), 5-year mortality was 26.6% (545/2049), 10-yr mortality was 48.1% (727/1513). Excluding ALF and redo LTs, death at 1-year mortality was 11.6% (228/1966), 5-year mortality was 25.9% (419/1616), 10-yr mortality was 49.3% (587/1178).Early mortality (<1-year post-LT) was attributed to technical and perioperative complications with multiple organ failure (MOF) (38%), infection (15%) and graft-related issues (12%). In patients who died >5-years post-LT, malignancy (20%), recurrent disease (16%), chronic rejection (13%) and renal/cardiovascular causes (11%) were observed as COD, with similar findings seen in those who died over 10 years post-LT. Among patients transplanted for MASLD (n = 99), 5-year follow-up was available for 77 patients (13.0% 5-yr mortality), 10-year follow-up was available for 23 patients (47.8% 10-yr mortality). Early mortality (<1 yr) was 12.1%. Mortality beyond 5 years for MASLD was heterogeneous and notably not attributable to cardiovascular disease. Donor type and graft number were important predictors of survival. Among deceased recipients, median survival was 1428 days (IQR 122–3908) for DBD grafts and 820 days (IQR 212–1861) for DCD grafts.Conclusions Temporal trends highlight a shift from early surgical and vascular complications towards oncological mortality and recurrent disease as predominant causes of death in the modern era and may signal a need for adoption of enhanced oncological screening practices. In order to further understand and optimise long-term survival post-LT, granular data with regards to cause of death as well as comorbidity profile at significant time points post-LT should be collected, as well as implementation of diagnosis-specific follow-up strategies.",
  "authors": [
    {
      "affiliations": [
        "Royal Free Hospital, London, UK"
      ],
      "name": "Krish Patel"
    },
    {
      "affiliations": [
        "Royal Free Hospital, London, UK"
      ],
      "name": "Margaret de Bethlen"
    },
    {
      "affiliations": [
        "Royal Free Hospital, London, UK"
      ],
      "name": "Beverley Kok"
    }
  ],
  "title": "P148 Outcomes following liver transplantation: a retrospective analysis of 1000 cases at a single centre",
  "uid": "90c452b2-e6da-53db-9783-e1424b138089"
}