[Liver transplantation. The Hannover experience]

Since 1972, 610 liver transplantations have been performed in 520 patients in Hannover, including 98 children from the age of 9 months. In 146 cases, the indications were nonresectable malignant tumors, in 274 cases benign diseases, mainly terminal cirrhoses of various etiologies. The results have been considerably improved, with the recipient's general condition being the key factor of the prognosis: in elective transplantations, the survival rate after one year is 90%, while in complicated or emergent cases, it is only 40-60%. Thus early surgery plays an essential part. The quality of life following liver transplantation is quite satisfactory, and the patients are very happy as a rule. Recurrence of the initial disease reduces the quality of life. Recurrence of malignant tumors, in particular, is frequent. Considerable progress was made in the surgical technique, including transplantation of a reduced liver in children, division of a donor liver in 2 parts, hepatectomy and maintenance of the liver-deprived condition during several hours to achieve the stabilization of hemodynamics, transplantation of auxiliary livers and finally, liver surgery off-site. Thus the accumulation of many elements of experience in liver transplantation has allowed developing new surgical techniques. Like for any organ transplantation, the ethical and economical issues must be constantly kept in mind.