Liver transplantation. Initial experience in the Veterans Administration

Area of Science:

• Transplantation Medicine
• Hepatology
• Surgical Outcomes

Background:

• The Veterans Administration (VA) initiated a liver transplantation program in 1983.
• The program operated until July 1988, serving as the sole authorized center for VA liver transplants.
• This study analyzes the early outcomes and challenges of the VA's liver transplant initiative.

Purpose of the Study:

• To evaluate the process of patient selection and transplantation within the VA system.
• To identify reasons for transplant denial and retransplantation.
• To assess the early survival rates and graft outcomes.

Main Methods:

• Retrospective review of patient data from 146 VA Medical Centers.
• Analysis of 101 patient evaluations and 67 liver transplantations (OLTx).
• Examination of reasons for transplant denial and retransplantation, including graft survival rates.

Main Results:

• 69% of initial contacts led to patient evaluation, with 76% accepted for OLTx.
• Common reasons for denial included metastatic cancer, alcoholism, and concurrent medical issues.
• The annual number of transplants increased from 1 to 21; retransplantation rate was 22% with 46% survival for second grafts.
• Reasons for retransplantation included rejection, hepatic artery thrombosis, and graft failure.

Conclusions:

• The VA liver transplant program demonstrated an increasing capacity for procedures during its operational period.
• Patient selection criteria and post-transplant complications, such as rejection and thrombosis, presented significant challenges.
• While early survival rates showed promise, retransplantation outcomes highlighted areas for improvement.