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The Queensland Liver Transplant Programme: the first two years.
1Queensland Liver Transplant Programme, Princess Alexandra Hospital, Woolloongabba.
The Medical Journal of Australia
|October 19, 1987
Summary
Orthotopic liver transplantation in Australia shows promising results, with 67% of patients surviving and discharged within 23 months. This early program demonstrated survival rates comparable to international standards.
Area of Science:
- Hepatobiliary Surgery
- Transplantation Medicine
- Gastroenterology
Background:
- Orthotopic liver transplantation (OLT) program initiated in Brisbane, Australia in January 1985.
- Initial two-year assessment involved 55 patients (38 adults, 17 children), with patients categorized as accepted, rejected, or deferred.
- Patients rejected for advanced disease had a uniformly poor prognosis, highlighting the critical need for timely transplantation.
Purpose of the Study:
- To evaluate the outcomes of the initial phase of an orthotopic liver transplantation program in Australia.
- To assess patient survival rates and identify factors influencing outcomes in the first two years of the program.
Main Methods:
- Retrospective analysis of 55 patients evaluated between January 1985 and January 1987.
- 21 orthotopic liver transplantations performed on 18 patients (13 adults, 5 children).
- Analysis of patient survival, graft procurement, causes of death, and the impact of pre-operative factors on outcomes.
Main Results:
- 67% (12 out of 18) of patients who received transplants were alive at 3-23 months post-operation and discharged from hospital.
- Graft procurement was predominantly local, with 15 out of 21 grafts from within Queensland.
- Causes of death included sepsis, aspiration pneumonitis, rejection, hepatic artery thrombosis, and hepatocellular carcinoma recurrence. Two patients required re-transplantation due to chronic rejection, and one for primary graft failure.
Conclusions:
- Orthotopic liver transplantation in Australia achieved survival rates comparable to established international centers during its initial phase.
- Pre-operative patient factors, including coma, ascites, malnutrition, and prior abdominal surgery, showed a partial correlation with operative blood loss and survival.
- The program demonstrated the feasibility and effectiveness of OLT in Australia, despite challenges such as donor liver availability and post-operative complications.