Liver transplantation: an Australian experience.

Area of Science:

• Hepatology
• Transplant Surgery
• Pediatric Gastroenterology

Background:

• 283 patients referred to Australian National Liver Transplant Unit over 4.5 years.
• 60% were children, with biliary atresia and inborn errors of metabolism as primary causes of liver failure.
• 197 patients (69%) were accepted for liver transplantation.

Purpose of the Study:

• To evaluate the outcomes of liver transplantation in Australia.
• To assess the efficacy of reduced-size adult grafts for pediatric recipients.
• To determine the survival rates and identify factors influencing graft success.

Main Methods:

• Analysis of 283 referred patients and 100 liver grafts transplanted over 4.5 years.
• Comparison of survival rates based on patient age, weight, underlying condition, and graft type.
• Evaluation of graft survival and patient rehabilitation post-transplantation.

Main Results:

• Overall 1-year survival was 73%, with 67% at 2-4 years. Adults with benign conditions had 76% survival, contrasting with 20% for malignancy.
• Children >8 kg had good outcomes (75-80% survival), while infants <8 kg receiving reduced adult grafts had 20% survival.
• 100% survival for fulminant hepatic failure patients, including those receiving ABO-incompatible grafts; 91-94% of survivors achieved excellent rehabilitation.

Conclusions:

• Liver transplantation is highly effective for benign liver disorders but less so for malignancy.
• Reduced-size adult livers are successful for pediatric patients, alleviating donor shortages.
• ABO-incompatible grafts can be lifesaving in urgent situations, though retransplantation may be needed.