Experiences with liver transplantation in Hannover

Ninety orthotopic liver transplantations in 86 patients performed between 1972 and 1983 in the Medical University of Hannover are reviewed. Results in tumor patients (n = 46) are characterized by a high rate of early tumor recurrence. A few patients survived for prolonged periods, and some were cured. More experience is required to define more precisely suitable kinds and stages of malignancies so that liver grafting in tumor patients can be confined to situations with a favorable prognosis. The main problem of liver transplantation in cirrhotics (n = 40) is the appropriate time of indication. It is suggested that liver grafting be performed more often in an "elective" situation. This phase during the course of cirrhosis must be optimally defined by analysis of the underlying disease and by individual situation. Results of liver grafting in elective situations are better than those in emergency situations and may offer a tangible chance for cure. Liver grafting in pediatric patients gives the best results, although procurement of small donor organs is a major problem. More experience, better immunosuppression with cyclosporin A, and the search for the appropriate time of indication contribute to improvement in the results of liver grafting.