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21 May 2009

Liver transplantation

M Krawczyk

Ann Transplant 2009; 14(1): 13-13 :: ID: 880242

Abstract

Background: The clinical consensus about liver transplantation was established
in Bethesda in the USA in 1983 and accepted all over the world. The liver transplant program in Poland started in the Children's Memorial Health Institute in 1990. In the Department of General, Transplant and Liver Surgery the program of began in 1994. Now we have five active liver transplantation Centers in Poland. Two of them are in our University in Warsaw. The third one is located in the Children's Hospital in Warsaw. One center is localized in Szczecin and the fifth one in Katowice.
Material/Mathods: The number of liver transplantations in Poland was increasing till 2006. However, now we are experiencing the same problem as in the rest of the world, namely that a shortage of donors has stopped the continuing of progress in liver transplantation. In Poland we perform over 85% of liver transplantations using the piggy-back method. The main indication for liver transplantation is the same as in other countries - it is liver cirrhosis, then cholestatic diseases, metabolic diseases, acute liver insufficiency and liver tumors. Hepatitis C and hepatitis B are the main causes of cirrhosis and therefore for liver. transplantation. - 35.5% of our cases. Cholestatic diseases were the indication for transplantation in 23%. Alcoholic cirrhosis has also important position - accounting for almost 15% of all patients. Acute liver failure was indication for transplantation in 7%. Varies types of tumors were the indication for liver transplantation in 8.2% of our group. We fully accept the Milano criteria for liver transplantation eg. we accept to transplantation majority of patients with toumor less than 5 cm diameter. In several cases it was performed liver transplantation due to metastatic endocrine tumors. The lack of cadaveric donors organs, especially for child recipients, led to development of the programme of organs transplantation from the living-related donors.
Results: One year survival after liver transplantation in Poland is over 85%. The number of vascular complications after liver transplantation were not very high. We observed arterial thrombosis in below 5% of our patients. The number of vascular complications decreased in parallel to the increase in our surgical experience. Biliary complications were and are till today the Achilles heel of liver transplantation. At the beginning we mandatory used the drainage after biliary anastomosis and we observed over 25% biliary complications. So after 2000 year we changed our policy. And now we do the biliary anastomosis without stenting. The number of biliary complication was reduced to 8%. It is possible to see the same trend with the percentage of mortality. 1 year mortality in 1996 was over 30%. Now it is below 10%. That means that liver transplantation is now a safe operation. 77% of our HCC patients were within Milano criteria. After the operation, 3 years survival for this group of patients is over 80%. Till the end of 2008 we have performed 145 living related liver transplantations. The majority of operations were done in children. In 90% of cases, the parents were donors of part of their liver for their children. In the majority of cases it was harvested segment II and III, more rarely II,III and IV or V-VIII. The important point is that harvesting of part of the liver for transplantation is safe. The percentage of complications is only 8%. There was 0% mortality in our material. 93% of donors returned to normal life within 6 months of the operation. The results of the LRLT are excellent as you can see in this slide - 92% percent survival.
Conclusions:
• Liver transplantation like other complex surgical operations requires highly experienced team of specialists
• Good results after OLT are obtained after performing dozens of such  procedures
• After reaching a certain level of experience no signifi cant improvement of results has been observed
• Living related liver transplantation is safe procedure and with excellent results.

Keywords: Liver Transplantation, Hepatitis C, Hepatitis B

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358