Liver Transplantation in Patients with Cryptogenic Cirrhosis Provides Excellent Long-Term Outcome.

BACKGROUND: Cryptogenic cirrhosis (CC) is an indication for liver transplantation in 5-9% of recipients. Diagnosis is made when other diagnostic possibilities have been ruled out. The aim of this study was to present long-term outcomes of liver transplantation for CC.

MATERIAL AND METHODS: There have been 1367 liver transplantations performed during the years 1994-2013 in the Department of General, Transplant and Liver Surgery at the Medical University of Warsaw. This retrospective study comprised 55 patients after liver transplantation for CC (4.0%). Perioperative mortality (30 days) and patient and graft 1-, 5-, and 10-year survival rates were set as outcome measures.

RESULTS: Peri-operative mortality reached 10.9% (6 of 55). The 1-, 5- and 10-year patient and graft survival rates were 85.2%, 78.8%, and 73.9%, respectively, and 83.3%, 74.5%, and 74.5%, respectively. In univariate analyses, the following parameters significantly influenced patient survival: pre-operative aspartate (AST; p=0.013) and alanine (ALT; p=0.043) aminotransferases activity, INR (p=0.040), bilirubin concentration (p=0.045), and donor age (p=0.033). Similarly, graft survival was significantly associated with AST (p=0.013), ALT (p=0.043), bilirubin concentration (p=0.044), INR (p=0.038), and recipient sex (p=0.049). In multivariable analyses, a tendency towards worse patient and graft survival was observed in patients with higher pre-operative AST (p=0.078 for patient survival and p=0.063 for graft survival). Analyses of the pathological reports indicated that underlying immunological processes were the most probable cause of liver damage in 16 of 51 patients (31.4%).

CONCLUSIONS: Long-term outcomes of liver transplantation in patients with cryptogenic liver cirrhosis are encouraging. Analysis of the clinical course, biochemical parameters, and factors influencing outcomes suggest an underlying autoimmunological etiology of cirrhosis in this population of patients.