Résumé
Advances in immunosuppressive therapy, improved surgical expertise, and early diagnosis and management of complications after liver transplantation (LT) have led to a gradual improvement in survival rates post LT. Data regarding the long-term mortality and late complications after LT in patients receiving modern immunosuppressive agents (TAC+MMF) is scarce. Therefore, the aim of this study was to determine the long-term mortality and causes of death after LT and the related risk factors for death in the era of modern TAC+MMF immunosuppression in a large, multicentre cohort of French LT recipients.Patients and Methods: 259 adult patients who underwent LT between 2008 and 2013 in the Liver Transplantation Units of Montpellier, Lyon, Lille, and Toulouse University Hospitals (France) with a protocolized follow up at 1, 3, 5 and 10 years post LT, through October 2021, were included.Results: the cohort was predominantly male (74%) with mean age of 53±11.3 years. Alcohol liver disease (ALD) was the most common primary underlying aetiology, occurring in 31% of recipients. The mean MELD pre-LT score was 16.4±8.4. The median follow-up was 8 years [range 2.4–10.1]. Overall patient survival at one, three, five, and ten years post-transplant was 84%, 76%, 72% and 64.4%, respectively. The risk of death was highest during the first year, decreasing and stable until eight years, then increased thereafter. Ninety-eight patients died during follow-up. Of these, 23 (23.4%) died of hepatic causes, 64 (64.3%) of non-hepatic causes, and 12 (12.2%) of unknown causes. Risk factors associated with overall death, by univariate analysis, included: pre-LT age >56 years (HR 1,63), preLT diabetes (HR 1,53), pre-LT history of coronaropathy (HR=2,19), metabolic liver disease (HR 3,45), post-LT overweight (BMI >25) (HR=0,5), post-LT renal insufficiency (GFR <60 mL/min), late rejection (HR=2,7), graft vascular complications (HR=2,78) and post-LT malignancy (HR=2,37) (p<0,05).Conclusion: outcomes from LT have markedly improved over the last few decades. Cardiovascular events are the leading cause of early post-transplant mortality, while malignancy is the leading cause of late mortality.