Can liver transplantation provide the statistical cure?

Liver Transplantation

Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)

Original Article

A. Cucchetti M.D^1,*, A. Vitale M.D., Ph.D.², M. Cescon M.D. Ph.D.¹, M. Gambato MD³, L. Maroni M.D.¹, M. Ravaioli M.D. Ph.D.¹, G. Ercolani M.D.¹, P. Burra M.D., Ph.D.³, U. Cillo M.D., Ph.D.², A.D. Pinna M.D. Ph.D.¹

DOI: 10.1002/lt.23783

Publication History
Accepted manuscript online: 26 OCT 2013 04:38AM EST
Manuscript Accepted: 19 OCT 2013
Manuscript Revised: 16 SEP 2013
Manuscript Received: 25 JUN 2013

©2013. American Association for the Study of Liver Diseases

Keywords:Liver transplantation; cure model; relative survival; excess hazard rate

ABSTRACT

Liver transplantation (LT) represents the only chance of long-term survival for patients with end-stage liver disease. When the mortality among transplanted patients returns to the same level as in the general population, they can be considered “statistically cured”. However, cure models in the setting of LT have never been applied. Data from 1371 adult patients, undergoing a first LT between January 1999 and December 2012 at two Italian centers, were reviewed in order to establish probabilities of being cured by LT. A parametric Weibull model was applied to compare mortality after LT to that expected in the general population, matched by sex and age. The observed 3-, 5- and 10-year overall survival after LT was 77.8%, 73.3% and 65.6%, respectively, and did not differ between the two centers (P=0.366). The cure fraction for the entire study population was 63.4% (95%CI: 52.6%–72.0%) and the time-to-cure was 10 years with 90% of confidence level. The best cure fraction was observed for younger non-hepatitis C (HCV) recipients with favorable donor-recipient match, namely low Donor-Model for End-stage Liver Disease (D-MELD) scores (90.1%); conversely, the lowest probability was observed in elderly HCV recipients with high D-MELD scores (34.6%). The time-to-cure was 6.22 years for non-HCV patients and 14.78 years for HCV patients. Median survival of “uncured” patients was 2.29 years. Among uncured recipients, the longest survival was observed for younger patients (7.31 years). In conclusion, we provide here a new clinical measure in the LT scenario that suggests that survival after transplantation can approximate that of general population, providing the “statistical cure”. Liver Transpl , 2013. © 2013 AASLD.

Source