*Purpose: This single center study reviews long-term outcomes of liver transplantation identifying morbidity differences between post-transplant liver patients surviving greater than five years versus those expiring earlier. Furthermore, co-morbid conditions were evaluated between long-term liver transplant survivors versus patients expiring greater than 5 years after transplant.

*Methods: Medical records of 877 consecutive patients undergoing liver transplant at our institution from January 2009 to June 2014 were retrospectively reviewed. 187 patients (21.3%) were lost to follow-up within the first 5 years post-transplant; a total of 690 patients were included in the analysis.

*Results: Most patients undergoing liver transplantation at our center were alive at last follow-up, greater than 5 years post-transplant (482, 69.9%). 165 patients (23.9%) died within five years of transplant and 53 patients (7.6%) died greater than 5 years post-transplant. Average age of death in the early post-transplant group was 60.8 years versus 67.1 years in the late post-transplant group (p<0.01). Early post-transplant cause of death was more likely to be liver disease related, 12.7% versus 3.8% (p<0.001), or secondary to sepsis, 9.7% versus 3.8% (p<0.001). Late post-transplant morbidity included malignancy (22.6%), pulmonary (13.2%), and renal (7.5%). Most common cause of death in both groups was undetermined (40% early post-transplant, 47.2% late post-transplant, p = 0.36).

Comorbid conditions were compared between liver recipients surviving at least 5 years post-transplant (n=482) versus patients who expired late (>5 years) post-transplant (n=53). Malignancy rate was 42.9% in survivors versus 50.9% in the late mortality group (p =0.27). Most commonly observed malignancy was skin cancer (32.6% vs 28.3%, p=0.39), followed by recurrent HCC (0.8% vs 7.5%, p<0.01), and PTLD (0.8% vs 1.9%, p=0.45), respectively. Hyperlipidemia (31.7% vs 17%, p=0.03) and hypertension (68.7% vs 45.3%, p<0.001) were seen more commonly in long-term survivors. No statistically significant difference was observed in rates of diabetes (39.4% vs 41.5%, p=0.88) or obesity BMI >30 (36.7% vs 26.4%, p=0.14). Similar rates of alcohol recidivism were observed (2.9% vs 3.8%, p=0.12).

*Conclusions: Liver transplantation offers significant long-term survival benefit. Patients surviving longer than 5 years post-transplant are less likely to die of liver-related disease or sepsis than those expiring early post-transplant. Alcohol recidivism, malignancy, and metabolic comorbidities are similar in long-term survivors of liver transplant versus those recipients expiring late post-transplant. Further studies on factors associated with survival may allow for risk factor modification in long-term post-liver transplant patients.

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