P121 Late mortality following liver transplantation

<h3></h3> Liver transplant recipients are reported to have lower survival than the general population due transplant-related complications and increased risks of malignancy and severe infections. This study aimed to examine factors associated with late mortality, defined as death between one and five years, following liver transplantation at a high-volume liver transplant centre in the UK. We performed a single-center retrospective analysis of prospectively collected data from all 745 adult patients that received a first liver graft at Queen Elizabeth Hospital Birmingham between September 2014 and December 2018 while on the routine waiting list. Kaplen-Meier analyses were used to calculate survival probabilities, with the log-rank test used to compare survival between groups. Late mortality was defined as death between one and five years following liver transplantation. Factors associated with late mortality were identified by comparing patients with late mortality and surviving patients using the Mann-Whitney U-test and Fisher’s exact test. Causes of death were determined from the medical certificate of cause of death, correspondence from local teams or review of case notes. The predominant aetiologies in this cohort were alcohol-related liver disease (ArLD, 24.8%), hepatocellular carcinoma (HCC, 21.5%) and primary sclerosing cholangitis (PSC, 14.6%). Overall one-year and five-year survival was 93.3% and 80.3%, respectively. Patients transplanted for HCC had significantly lower five-year survival compared to patients transplanted for ArLD or PSC. Of the 745 patients, 50 had early mortality (6.7%) and 91 had late mortality (12.2%). Greater recipient age and donor age were associated with late mortality. MELD score and recipient BMI at time of transplantation were not associated with late mortality. Donor BMI and the presence of graft steatosis were not associated with late mortality. Causes of death were known in 77 of 91 patients with late mortality. De-novo cancer (28.6%), HCC recurrence (22.1%), and infection (19.5%) were the commonest causes of late mortality. Of the 29 patients transplanted for HCC with late mortality, 17 had HCC recurrence (58.6%). Recidivism contributed to the deaths of 8 of the 23 patients transplanted for ArLD with late mortality (26.1%). The present study describes the experience of a large UK transplant centre and identifies potentially modifiable factors associated with late mortality following liver transplantation including de novo cancers, HCC recurrence and recidivism. These results highlight the importance of patient selection when considering transplantation for HCC, screening for de novo cancers post-transplantation, and the careful assessment and follow-up of patients at risk of recidivism.