LIVER-TRANSPLANTATION IN WESTERN-AUSTRALIA - IMPROVED SERVICES TO AN ISOLATED POPULATION

Objective: To assess performance of the Western Australian Liver Trans plantation Service in the light of debate about whether small transpla nt centres can produce optimal outcomes. Design: Review of patient dat a collected prospectively and confirmed by retrospective casenote revi ew, Subjects: All patients referred to the Western Australian Liver Tr ansplantation Assessment Panel. Those who underwent transplantation at the Western Australian Liver Transplantation Service (to June 1996) w ere compared with those referred to other transplant centres before th e elective service was established in July 1994. Outcome measures: Num bers of referrals and transplants; characteristics of the transplantat ion procedure; and patient outcomes. Results: Annual referrals for liv er transplant in Western Australia (WA) increased from 12 (1985-1993) to 41 (July 1994-June 1996), with five deaths on the ''activated'' lis t before July 1994, but none after, To June 1996, 30 patients had rece ived 31 transplants by the Western Australian Liver Transplantation Se rvice (two emergency transplants in 1992 and 1993, respectively, and 2 8 elective transplants and one retransplant after June 1994), with med ian operation time of 5.5 hours (range, 3-10.5), median red cell trans fusion of 4 units (range, 0-55) and median hospital stay of 24 days (r ange, 12-128). There was no severe primary graft dysfunction. Major co mplications included hepatic artery thrombosis or stenosis (5 patients , one requiring retransplant), biliary stricture not associated with h epatic artery pathology, bile leak and perihepatic abscess (4 each), a nd cytomegalovirus infection (3). Patient survival was 83% and graft s urvival 81% at a mean follow-up of 13 months, compared with 86% and 83 %, respectively, at one year for WA patients who received transplants elsewhere before July 1994. Conclusions: Performance of the Western Au stralian Liver Transplantation Service compares favourably with nation al and international standards, and WA patients receiving liver transp lants have increased dramatically since the service was established. T his supports the viability of committed liver transplantation centres with only 10-15 patients a year and argues the need for nationally dec entralised services.