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Open Access Research article

Survival of patients with alcoholic and cryptogenic cirrhosis without liver transplantation: a single center retrospective study

Sudul Mananjala Senanayake1, Madunil Anuk Niriella12, Sanjaya Kumara Weerasinghe2, Anuradhani Kasturiratne3, Jerome Praneeth de Alwis2, Arjuna Priyadarsin de Silva12, Anuradha Supun Dassanayake4 and Hithanadura Janaka de Silva12*

Author Affiliations

1 University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka

2 Departments of Medicine, Ragama, Sri Lanka

3 Departments of Public Health, Ragama, Sri Lanka

4 Departments of Pharmacology, Faculty of Medicine, University of Kalaniya, Ragama, Sri Lanka

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BMC Research Notes 2012, 5:663  doi:10.1186/1756-0500-5-663

Published: 2 December 2012

Abstract

Background

There is no recent data addressing the long term survival of cirrhosis patients without transplantation, but with the availability of optimal pharmacological and endoscopic therapies. We compared the long term transplant free survival of alcoholic (AC) and cryptogenic (CC) cirrhosis patients in a setting where liver transplantation was, until very recently, not available. AC and CC patient details were extracted from our database, maintained since 1995. For those who had not attended clinics within the past 4 weeks, the patient or families were contacted to obtain survival status. If deceased, cause of death was ascertained from death certificates and patient records. Survival was compared using Kaplan-Meier curves.

Results

Complete details were available in 549/651 (84.3%) patients (AC 306, CC 243). Mean follow up duration (SD) (months) was 29.9 (32.6). 82/96 deaths (85.4%) among AC and 80/94 deaths (85.1%) among CC were liver related. Multivariate analysis showed age at diagnosis and Child’s class predicted overall survival among all groups. The median survival in Child’s class B and C were 53.5 and 25.3 months respectively. Survival was similar among AC and CC. Among AC survival was improved by abstinence [HR = 0.63 (95% CI: 0.40-1.00)] and was worse with diabetes [HR=1.59 (95% CI: 1.02- 2.48)] irrespective of alcohol status.

Conclusions

The overall survival of AC was similar to CC. Death in both groups were predominantly liver related, and was predicated by age at diagnosis and Child class. Among AC, presence of diabetes and non-abstinence from alcohol were independent predictors for poor survival.

Keywords:
Alcoholic cirrhosis; Cryptogenic cirrhosis; Transplant-free survival