A liver transplant is a major surgery that replaces a failing, damaged, or diseased liver with a healthy liver from a donor. It is typically the last resort treatment option for patients with end-stage liver disease or acute liver failure. While liver transplantation can be lifesaving, it does carry risks including the chance of death.
What is the Overall Mortality Rate for Liver Transplants?
According to research, the overall mortality rate for liver transplant patients is between 5-15%. This means that within a year of the transplant surgery, between 5-15% of liver transplant recipients will pass away. The chance of death is highest right after the liver transplant surgery. Studies show that in the first 30 days after a liver transplant, the mortality rate ranges from 4-10%.
Some of the most common causes of death shortly after a liver transplant include primary graft nonfunction, vascular complications, sepsis, multi-system organ failure, and cardiovascular events. Later deaths are often related to consequences of long-term immunosuppression like infection, recurrence of liver disease, and development of malignancy.
How Age Affects Liver Transplant Mortality Rates
Age is one of the biggest factors that impacts the mortality rate after a liver transplant. Older patients generally have higher rates of death compared to younger patients.
According to studies, here are the general mortality rates by age groups:
Patients Under 18 Years Old
– 1 year survival rate: 94%
– 5 year survival rate: 90%
– 10 year survival rate: 90%
Patients Between 18-50 Years Old
– 1 year survival rate: 90%
– 5 year survival rate: 85%
– 10 year survival rate: 80%
Patients Over 50 Years Old
– 1 year survival rate: 85%
– 5 year survival rate: 65%
– 10 year survival rate: 50%
As the data shows, the chance of dying after a liver transplant climbs steadily with age. Patients over 50 have the highest mortality rates.
How Donor Type Impacts Liver Transplant Survival Rates
The type of liver donor also affects the mortality rate after a transplant. There are two main types of liver donors:
Living Donor
This is when a living person donates a portion of their liver. The donor is typically a relative, spouse or friend.
Deceased Donor
This is when a liver comes from a person who has recently passed away.
Here is a comparison of the survival rates by donor type:
| Donor Type | 1 year survival rate | 5 year survival rate |
|---|---|---|
| Living Donor | 95% | 90% |
| Deceased Donor | 85-90% | 65-70% |
As shown, getting a liver from a living donor provides better odds of long-term survival compared to livers from deceased donors. But deceased donor transplants still have good survival rates.
How the Cause of Liver Failure Impacts Mortality
The reason why a person needs a new liver can also affect their chance of survival after transplant.
Here are the mortality rates based on the cause of liver failure:
| Cause of Liver Failure | 1 year survival rate | 5 year survival rate |
|---|---|---|
| Chronic Hepatitis C | 85-90% | 65-75% |
| Chronic Hepatitis B | 80-85% | 60-70% |
| Alcoholic Cirrhosis | 85-90% | 65-75% |
| Non-Alcoholic Fatty Liver Disease | 90-95% | 75-85% |
| Autoimmune Hepatitis | 90-95% | 75-85% |
| Primary Biliary Cholangitis | 85-90% | 65-75% |
| Primary Sclerosing Cholangitis | 85-90% | 65-75% |
In general, transplants for autoimmune hepatitis, non-alcoholic fatty liver disease, and acute liver failure tend to have better survival rates. Transplants for hepatitis B and C tend to have slightly higher mortality rates, but outcomes can vary widely.
How Transplant Center Volume Impacts Outcomes
The volume of liver transplants performed at a transplant center also influences patient mortality rates. Centers that do a high number of liver transplants each year tend to have better patient survival.
Here is a overview of how center volume impacts transplant mortality rates:
| Liver Transplants Per Year | Patient Mortality Rate |
|---|---|
| 20 or less | 15-20% |
| 20-50 | 10-15% |
| 50-100 | 8-12% |
| 100 or more | 5-10% |
Patients who get their transplant at centers that perform over 100 liver transplants a year have the best outcome chances. The experience and expertise at high-volume centers leads to reduced mortality rates.
Impact of Post-Transplant Complications
Experiencing complications after a liver transplant can also increase the risk of mortality. Here are some key complications that can impact the chances of survival:
Primary Graft Dysfunction
This is when the new liver fails to function properly shortly after transplant. It occurs in 5-25% of liver transplant recipients. Primary graft dysfunction ups the risk of 30-day mortality by 2-3 times.
Vascular Complications
Issues like hepatic artery thrombosis, portal vein thrombosis, and hepatic vein stenosis can affect blood flow to the liver. These vascular complications increase the risk of early liver failure and death.
Bile Duct Complications
Bile duct issues like bile leaks and strictures occur 15-30% of the time after liver transplant. Infections and liver dysfunction resulting from bile duct complications can be fatal if not treated promptly.
Rejection
When the recipient’s immune system attacks the donor liver, it results in acute rejection. Rejection increases the risk of graft failure and reduced survival. However, most rejection can be managed with medications and does not always lead to death.
Recurrence of Liver Disease
For conditions like hepatitis B, hepatitis C and alcoholic cirrhosis, the original liver disease can come back and damage the new liver. Recurrence significantly impacts long-term patient and graft survival.
Post-Transplant Lymphoproliferative Disorder (PTLD)
This is a type of lymphoma that develops due to immunosuppression medications after transplantation. PTLD has a high mortality rate when severe, rapidly progressive disease occurs.
How Long Do Liver Transplant Patients Live?
Here is an overview of expected survival times after a liver transplant:
– After 1 year – Survival rate is 90-95%
– After 5 years – Survival rate is 70-90%
– After 10 years – Survival rate is 60-85%
Long-term survival continues to decline over time due to complications like chronic rejection and side effects of immunosuppression. However, many liver transplant recipients can live a healthy life for 20 years or longer with their new liver.
Conclusion
While liver transplantation is a major operation with risks, survival rates have improved significantly over the decades thanks to advances in organ preservation, surgical techniques, and post-transplant care.
Careful evaluation and management of transplant recipients can help reduce the chance of mortality after liver transplantation. With proper treatment and preventative care, many patients can enjoy prolonged survival and an improved quality of life after receiving a new liver.
