EVALUATION OF LIVER-TRANSPLANTATION FOR HIGH-RISK INDICATIONS

Background Appropriate use of orthotopic liver transplantation (OLT) r equires 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 recur rent disease (patients with tumours, hepatitis B- or hepatitis C-induc ed 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 pe r cent respectively. The overall survival rate of high-risk patients w as significantly lower than that for all OLT recipients (P < 0.05). Wh ile no patients transplanted for hepatitis C have developed graft fail ure, recurrent hepatitis occurred in 15 of 35 patients. Conclusion Str ict selection criteria and appropriate perioperative investigations an d interventions are required to improve the results of OLT in these hi gh-risk patients.