Short- and long-term mortality after liver transplantation in patients with and without hepatocellular carcinoma in the UK

Background The increasing demand for liver transplantation has led to considerable changes in characteristics of donors and recipients. This study evaluated the short- and long-term mortality of recipients with and without hepatocellular carcinoma (HCC) in the UK between 1997 and 2016. Methods First-time elective adult liver transplant recipients in the UK were identified and four successive eras of transplantation were compared. Hazard ratios (HRs) comparing the impact of era on short-term (first 90 days) and longer-term (from 90 days to 5 years) mortality were estimated, with adjustment for recipient and donor characteristics. Results Some 1879 recipients with and 7661 without HCC were included. There was an increase in use of organs donated after circulatory death (DCD), from 0 per cent in era 1 to 35 center dot 2 per cent in era 4 for recipients with HCC, and from 0 center dot 2 to 24 center dot 1 per cent for non-HCC recipients. The 3-year mortality rate decreased from 28 center dot 3 per cent in era 1 to 16 center dot 9 per cent in era 4 (adjusted HR 0 center dot 47, 95 per cent c.i. 0 center dot 35 to 0 center dot 63) for recipients with HCC, and from 20 center dot 4 to 9 center dot 3 per cent (adjusted HR 0 center dot 44, 0 center dot 36 to 0 center dot 53) for those without HCC. Comparing era 4 with era 1, improvements were more marked in short-term than in long-term mortality, both for recipients with HCC (0-90 days: adjusted HR 0 center dot 20, 0 center dot 10 to 0 center dot 39; 90 days to 5 years: adjusted HR 0 center dot 52, 0 center dot 35 to 0 center dot 75; P = 0 center dot 043) and for non-HCC recipients (0-90 days: adjusted HR 0 center dot 32, 0 center dot 24 to 0 center dot 42; 90 days to 5 years: adjusted HR 0 center dot 52, 0 center dot 40 to 0 center dot 67; P = 0 center dot 024). Conclusion In the past 20 years, the mortality rate after liver transplantation has more than halved, despite increasing use of DCD donors. Improvements in overall survival can be explained by decreases in short-term and longer-term mortality.