Purpose: Liver transplantation (OLT) is an established treatment with excellent early outcome. However, the long-term results are hampered by side effects of immunosuppression, cardiovascular morbidity, recurrent disease, and chronic rejection. We analyzed causes of late death (>/=2 years post-OLT) in 679 consecutive primary recipients in our institution.

Materials and methods: A total of 679 primary OLT recipients including those retransplanted within 3 months between January 1985 and August 2005 were identified; 460 (67.7%) patients survived >/=2 years. The indications were cholestatic disease (35.1%), postviral (11.4%), alcoholic (12.9%), fulminant hepatic failure (7.0%), cryptogenic (3.1%), autoimmune hepatitis (4.8%), malignancy (7.7%), and others (18.0%). Sixty three patients (9.3%) died >/=2 years post-OLT. For 51 patients, sufficient records were present to establish the cause of death.

Results: Four hundred sixty (67.7%) patients survived >/=2 years. Their median age was 58 years with, 43.7% older than 60 and 11.1% older than 70 years. Sixty three patients (9.3%) died at a median time of 69 +/- 4.8 months post-primary OLT; 49.1% died of malignancy and 13.7% of vascular complications and infectious complications respectively.

Conclusions: Late mortality in our material is mainly due to malignant disease. Compared to other published reports on late mortality, the proportion of malignancy, especially recurrent, as cause of late death is higher. This might reflect a more generous approach toward accepting older patients and a higher proportion of patients with various malignant diseases accepted for OLT.