S2752 Long-Term Survivorship After Liver Transplantation—A Study of the US National Cohort

Introduction: We aimed to characterize the mortality trends in patients who survived liver transplantation (LT) for >5 years in the US. Long-term outcomes are mostly unknown, as transplant centers are attuned to 1, 3, and 5-year post-LT outcomes. Methods: We analyzed adult patients who underwent LT between February 2002 and September 2018 (UNOS cohort) and followed them until September 2024. Among 101,017 patients who underwent LT, after excluding retransplants and lost to follow-up, 87,693 were included. Causes of death (COD) and death rates (DR) were calculated in 5-year intervals after 5 years post-LT. Trends were compared across 2 different time intervals: Group T1 (2002-2010) and Group T2 (2011-2018). Results: Median age at LT was 56 (IQR 30-62), 66.4% were man, 72.1% were White. Analyzing COD; malignancy (6.9%), cardiovascular (CV) events (5.3%), infection (3.9%), and graft failure [GF] (3.8%) were the leading causes. With every successive 5 year post-LT, there is a shift in the predominant COD. In 5–10 year post-LT, DR from malignancy was 27.9%, CV 16.4%, GF 8.8%, and infection 8.2%; but at 20–25-years, respective values were 17.8%, 21.6%, 3.8%, and 10.2%. At 20–25 years, CV was the most common COD, followed by malignancy, respiratory failure (RF), and infection. CV and infection showed a steady increase, whereas malignancy and GF showed a steady decrease over time. A similar trend was noted in gender specific DR analysis also, and as expected, COD from CV was lower in women. Analyzing trends in Groups T1 and T2, at 5–10-y malignancy and CV were the most common COD in both groups, but infections, GF and renal failure were lower in Group T2 (T1- 9.4%, 11.7% and 5.3%, T2- 6.6%, 5.4% and 3.2%). At 10–15 y, a marked increase in RF as COD was noted in T2 (15.4% vs 10.0% in T1). COVID-19 pandemic likely accounts for the surge in RF as COD at these time intervals. The following were independently associated with long-term death in a Cox-PH model (HR, CI)- age at LT (1.03, 1.03-1.03), pre-LT malignancy (1.08, 1.03-1.14), pre-LT diabetes (1.42, 1.36-1.47), poor performance status (1.22, 1.16-1.28), LT in Group T2 (0.86, 0.83-0.90), P < 0.001 (MELD at LT was not associated). Conclusion: COD post-LT has shown a shift with every successive 5 years; malignancy is the predominant cause in 5-10 years and CV in 20-25 years, in both genders. LT between 2010 and 2018 showed increased long-term survival compared to the previous decade, indicating refinement in LT care over time.