Early mortality after liver transplantation: Defining the course and the cause

Background: The objective of the current study was to define the incidence, as well as time course of mortality within the first year after liver transplantation. Methods: Data on adult, first-time liver transplant recipients transplanted between February 2002 and June 2016 were obtained from the United Network for Organ Sharing. Results: Among 64,977 who underwent liver transplantation, the incidence of 90-day and 1-year mortality was 5% and 10%, respectively. Although death associated with cardiovascular/cerebrovascular/pulmonary/hemorrhage was the most cause of death within the first 21 days (7-day: 53%), only 20% of liver transplantation patients died from these causes after 180 days. Infections were the most frequent cause of death during 30–180 days after liver transplantation. In contrast, after roughly 200 days from the time of liver transplantation, other causes of death were the most frequent cause of death. Although patients with autoimmune hepatitis, nonalcoholic steatohepatitis, and alcoholic cirrhosis had a similar risk of 1-year mortality, patients undergoing liver transplantation for viral hepatitis and hepatocellular carcinoma had an increased risk of 1-year mortality (viral: OR 1.56; hepatocellular carcinoma: OR 1.57; P <.001). Conclusion: Roughly, 1 in 10 patients died within the first year after liver transplantation. The cause of death had a notable, time-specific variation over the first year after liver transplantation.