Survival following liver transplantation: A population-based nested case-control study

Background: Liver transplantation is the gold standard treatment for end-stage liver disease. This study evaluates post-transplantation survival compared with the general population by quantifying standardized mortality ratios in a nested case-control study. Methods: Controls were noninstitutionalized United States inhabitants from the National Longitudinal Mortality Study. Cases underwent liver transplantation from 1990 to 2007 identified through the Organ Procurement and Transplantation Network database. Propensity matching (5:1, nearest neighbor, caliper 0.1) identified controls based on age, sex, race, and state. The primary endpoint was 10-year survival. Results: 62,788 cases were matched to 313,381 controls. The overall standardized mortality ratio was 2.46 (95% CI 1/4 2.44-2.48). The standardized mortality ratio was higher for males (2.59 vs. 2.25) and Hispanic patients (4.80). Younger patients and those transplanted earlier (1990-1995) had higher standardized mortality ratios. Conclusions: Liver recipients have a standardized mortality ratio 2.46 times higher than the general population. Long-term mortality has declined over time.