Document Detail


One thousand liver transplants. The lessons learned.
MedLine Citation:
PMID:  8185400     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the first 1000 liver transplants performed at UCLA Medical Center to determine factors responsible for improved results. SUMMARY BACKGROUND DATA: Liver transplant has evolved impressively since the first case was performed in 1963. The 1980s have highlighted this progress with the development of better organ preservation, standardization of operative procedure, improved immunosuppressive agents, and better understanding of patient selection. METHODS: The first 100 consecutive liver transplants (group 1) performed from February 1984 through October 1986 were compared with the last 200 (group 2) performed between September 1991 and June 1992. An analysis was made of donor use; changes in patient candidacy; patient care variables; morbidity and mortality; survival data; and hospital resource use. RESULTS: In group 1, 31% of donors were refused because of medical unsuitability compared with 4% in group 2 (p < 0.0001). In group 1, alcoholic patients comprised 1% of liver transplant candidates compared with 20% group 2 (p < 0.0001). High-risk patients (United Network for Organ Sharing criteria 4) only comprised 11% of patients in group 1 compared with 37% in group 2 (p < 0.0001). Operative time (7.6 hours compared with 5.4 hours), packed cell replacement (17 units compared with 9.5 units), intensive care unit stay (10 days compared with 5 days), and hospital stay (50 days compared with 31 days) were all significantly improved (p < 0.05). In group 1, the 1-year survival rate was 73% and improved to 88% in group 2 (p < 0.0001). CONCLUSIONS: Despite unfavorable donor characteristics (obesity, cause of death, age, hypotension), most organs function well and should not be refused based on history alone. The older and high-risk patient (renal failure, ventilator dependence, portal vein pathology, and so on) is routinely transplanted with good success. Despite liberalization of both donor and recipient criteria, patient survival after liver transplant is improved, use of hospital resources is maximized, and cost reduction is achieved.
Authors:
R W Busuttil; A Shaked; J M Millis; O Jurim; S D Colquhoun; C R Shackleton; B J Nuesse; M Csete; L I Goldstein; S V McDiarmid
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of surgery     Volume:  219     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  1994 May 
Date Detail:
Created Date:  1994-06-14     Completed Date:  1994-06-14     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  490-7; discussion 498-9     Citation Subset:  AIM; IM    
Affiliation:
Dumont-UCLA Transplant Center, Department of Surgery.
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MeSH Terms
Descriptor/Qualifier:
Adult
Child
Graft Survival
Humans
Liver Transplantation* / adverse effects,  mortality,  statistics & numerical data
Middle Aged
Reoperation
Risk Factors
Survival Rate
Tissue Donors
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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