Ten years of liver transplantation at Groote Schuur Hospital

Introduction. Liver transplantation has evolved from an experimental proced ure to being the treatment of choice for many patients with end-stage liver disease, and is performed on a routine basis in most major centres through out the world. However, certain situations peculiar to developing countries have a major impact on liver transplant programmes in these countries. We present the results of the liver transplant programme in Cape Town. Patients and methods. All patients undergoing orthotopic Liver transplantat ion at Groote Schuur Hospital and Red Cross War Memorial Children's Hospita l were included in this report. Standard surgical techniques were used for procuring the donor liver, the recipient hepatectomy and the subsequent imp lantation of the liver. All patients received standardised peri-operative m anagement; in particular, the immunosuppressive protocol consisted of cyclo sporin, steroids and azathioprine. Since October 1988, 83 patients have undergone 89 orthotopic Lives transpla nts. There were 44 adults and 39 children, the age range being from 6 month s to 56 years. The commonest indications for hepatic transplantation in adu lts included cryptogenic cirrhosis auto-immune hepatitis and primary sclero sing cholangitis. In children biliary atresia was the commonest cause of Li ver failure. Results. Of the 81 patients transplanted, 50 are alive and well with follow -up ranging from 2 months to 9.5 years. The cumulative graft survival rate was 72% at 1 year and 61% at 5 years. Six patients have undergone re-transp lantation and 1 patients have had combined liver/kidney transplants. ne nov o hepatitis due to hepatitis B virus (HBV) has occurred in 8 patients follo wing transplantation. Subsequent investigation has shown that 5 of the dono rs of these livers were hepatitis B core antibody (HBcAb)-positive, while i nformation on the remaining 3 was not available. Tuberculosis (TB) has been a significant problem in 4 patients, with 2 deaths precipitated by anti-TB drug-induced hepatitis. Post-transplant lymphoproliferative disorder was a lso responsible for significant postoperative morbidity Conclusion. Orthotopic liver transplantation has been established at Groote Schuur Hospital as the treatment of choice for selected patients with chro nic end-stage liver disease. However, hepatitis B and TB appear to present a problem. The particularly high prevalence of HBV carrier status in our do nor population may necessitate the use of living donors in the future.