Liver transplantation: the first 200 grafts in Birmingham.
Improvements in perioperative management in this series have been balanced by an increase in the proportion of high-risk patients grafted, such that no overall improvement in survival has occurred. We suggest that for each patient 2 separate groups of risk factors are relevant: 1. Risk factors related to the transplant procedure itself: These include previous major upper abdominal surgery, marked cerebral edema due to fulminant hepatic failure, and severe portal hypertension including patients with recent major variceal bleeding. 2. Risk factors related to the recovery phase: These include patients in hepatorenal failure before grafting and those with severe muscle wasting. Greater experience and refinements in surgical technique have improved the outcome for patients with risk factors limited to the first group. However, those with risk factors in both groups remain a difficult problem and a significant proportion of the fatalities occur in patients who have come through the operation only to be lost from complications in the postoperative period. We feel this is one of the most important areas for future efforts if the results of liver replacement are to improve sufficiently to merit a wider application.
Buckels
J A
JA
Liver Unit, Queen Elizabeth Hospital, Birmingham, England.
Buist
L
L
Aertz
R
R
Tisone
G
G
Quintero
G
G
Michell
I
I
McMaster
P
P
D004739:England / Q000453:epidemiology; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D008107:Liver Diseases / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D009926:Organ Preservation / Q000379:methods; D011182:Postoperative Care; D012086:Reoperation / Q000706:statistics & numerical data; D015996:Survival Rate