Related Experiment Videos
Evaluation of liver transplantation for high-risk indications
S W Chung1, P D Greig, M S Cattral
1Department of Surgery, Toronto Hospital, University of Toronto, Canada.
Background:
Appropriate use of orthotopic liver transplantation (OLT) requires continued assessment of the indications for transplantation as a number of diseases are associated with a poor prognosis. High-risk patients are those who have a poor survival or high incidence of recurrent disease (patients with tumours, hepatitis B- or hepatitis C-induced cirrhosis, fulminant hepatic failure or primary graft non-function). In addition, retransplantation may be associated with a poor outcome.
Methods:
A retrospective review was made of the records of all adult patients undergoing OLT at this hospital between October 1985 and July 1994.
Results:
A total of 396 liver transplants were performed in 364 patients. The 1- and 3-year actuarial survival rates were 81 and 69 per cent respectively. The overall survival rate of high-risk patients was significantly lower than that for all OLT recipients (P < 0.05). While no patients transplanted for hepatitis C have developed graft failure, recurrent hepatitis occurred in 15 of 35 patients.
Conclusion:
Strict selection criteria and appropriate perioperative investigations and interventions are required to improve the results of OLT in these high-risk patients.