Objective: To evaluate allograft function and Quality-of-Life (QOL) 20-years after liver transplantation (LT).
Summary Background Data: While LT is the treatment of choice for acute and chronic liver failure, long-term allograft function and recipient quality-of-life (QOL) remain undefined.
Methods: We performed a prospective, single-institution study of LT recipients surviving 20+ years. From 2/1/84-12/31/88, 293 patients (179-adults, 114-children) received 348 LTs. Graft function, QOL (SF-36; Liver Disease Quality-of-Life) and cognition (NeuropsychiatricImpairmentScale) were evaluated.
Results: After 20-years, 68 of 87 survivors (78%) retained original allografts. Twenty year survival for adults transplanted for HCC (20%) or HBV (16%) was lower than for other diagnoses (p<0.001). Actuarial 10-and 20-year survival were 56% and 52% (patient) and 49% and 42% (graft). Factors associated with 20-year survival are shown in the table.

	20 year survivors	Non-20 year survivors	P value
Age < 18 yr, %	53	33	0.01
Urgent transplantation, %	25	46	0.01
Retransplantation, %	9	19	0.02
Male, %	38	47	0.03
Rejection, %	35	27	0.03
Biliary complication, %	7	11	0.04
Total ischemia times (cold + warm), hr	6.2 ± 1.5	8.7 ± 2.3	0.05

Survivors’ laboratory values showed intact graft function: mean creatinine-1.2 mg/dL, bilirubin-3.2 mg/dL, albumin-3.9 g/dL, and INR-1.3. The majority (64%) completed school; 78% resumed employment. Compared to the general population, survivors had lower physical scores (p<0.01) but comparable mental scores. Overall QOL was significantly better than in patients with CHF, diabetes, depression, and ESLD.
Conclusion: Fifty-percent of LT recipients survive 20-years with intact graft function. Twenty-year survivors demonstrate better QOL than patients with chronic conditions and are free of cognitive deficits. LT is a durable operation which restores both long-term physiologic and psychologic well-being in patients with end-stage liver disease.