RESULTS OF 1052 LIVER TRANSPLANTATIONS

Objectives: The aim of this work was to evaluate outcome in a continuo us homogeneous series of more than 1000 liver transplantations in orde r to determine risk groups. Methods: Between November 1984 and Februar y 1995, 1052 isolated orthotopic liver transplantations were performed in 922 patients (530 males, 392 females; mean age 41.7 years; age ran ge 10 months - 78 years) at the Paul-Brousse Hospital liver transplant ation unit. Immunosuppression was based on ciclosporin in all patients with FK506 in the most recent cases. Results: Actuarial survival at 1 ,5 and 8 years for the 922 patients was 80.9, 71.7, and 69.1%. Certain factors affecting the intrinsic risk of transplantation were identifi ed and could be used to calculate supplementary risk due to one or mor e other risk factors. In adults under 55 years in UNOS stage 1 or 2 (n ot hospitalized at call in) transplanted after 1990 for non-recurrent (absence of cancer, non-viral disease) chronic liver disease, the risk of death at 1 year was 6.5% and 4.4% between the first and second yea r. For patients transplanted for acute liver failure and for patients transplanted for chronic liver disease in UNOS stade 3 or 4 (hospitali zed or in an intensive care unit at call in), there was a supplementar y risk of death at 1 year of 20.3%, 13.3% and 31.6% repectively. There was no supplementary risk of death in these three groups after 1 year . In patients over 55 years, there was a 4.4% supplementary risk durin g the first year after transplantation and a 2% increase between the f irst and second year. In patients transplanted for cancer, the supplem entary risk was 9.7% during the first year, 11.6% between the first an d second year and 2.1% between the third and fifth gear. Conclusions: On the basis of these results, it was possible to develop a method for assessing liver transplantation outcome in different units. The propo sed criteria is the 1 year survival of patients with the basic risk at one, without any supplementary risk, as well as the retransplantation index (mean number of grafts used per patient). For the Paul-Brousse u nit, this criteria is 93.5% (survival at 1 year) for a retransplantati on index of 1.1.