Survival after liver transplantation: Experience with 89 cases

Liver transplantation has become an accepted clinical modality in the treatment of end-stage liver disease since the early eighties. In this paper, the result of liver transplantation at the largest liver transplant center in Saudi Arabia is presented with a special emphasis on the difficulties hindering the expansion of such programs.

A series of 89 liver transplant procedures was performed between January 1994 and June 1998. This is the largest series of liver transplant cases reported to date in Saudi Arabia. Patient data were retrospectively analyzed with a special emphasis on mortality and morbidity. Kaplan-Meier technique was used to compute patient survival.

The final outcome of the transplants was found to be comparable to that of well-established programs in Western Europe and North America. The actuarial survival rate at three months and one year was 98% and 89%, respectively. The long-term survival rate (>3 years) was 67%. Technical complications were well below average. The dominating cause of early death was sepsis. Late death was generally due to disease recurrence and chronic rejection.

Liver transplantation has been successful in Saudi Arabia. However, the main obstacle to program expansion and, therefore, the salvage of patients with end-stage organ failure, is lack of organs. This situation can be resolved only if all parties involved in organ transplantation in Saudi Arabia take serious steps towards the alleviation of the problem of organ shortage. Improvement in the donor situation in the Kingdom should result in timely retransplantation of patients with primary graft non-function and hepatic artery thrombosis, and will certainly enhance their chances of survival.