Cohort study reveals recurrent and de novo cirrhosis occurs in 11.4% of liver transplant recipients, highlighting reduced 20-year graft recipient survival.
Key Points
To evaluate the incidence, underlying etiologies, and long-term survival impact of recurrent and de novo cirrhosis following liver transplantation for end-stage liver disease.
Conducted a single-center retrospective study of 937 consecutive adult liver transplant recipients with pre-transplant cirrhosis followed between January 1, 1987, and December 31, 2023, excluding active hepatitis C infection and non-cirrhotic indications.
Defined post-transplant cirrhosis by histological bridging fibrosis or clinical signs of portal hypertension, and evaluated mortality risk using propensity score matching and Kaplan–Meier analysis.
Post-transplant cirrhosis developed in 107 of 937 patients (11.4%) at a median time of 7.8 years (IQR: 8.3), with 83.2% (89/107) caused by recurrent disease and 16.8% (18/107; 1.9% overall) occurring de novo.
Etiologic recurrence was highest in patients transplanted for autoimmune hepatitis (16/55, 29.1%) and primary biliary cholangitis (11/52, 21.2%), while de novo cases were primarily driven by chronic rejection (9/18) and metabolic dysfunction-associated steatohepatitis (4/18).
Recipients developing cirrhosis after transplantation had significantly lower 20-year post-transplant survival compared to those without cirrhosis (50.6% vs. 70.7%; HR: 1.77, 95% CI: 1.09–2.88; p < 0.05).