title: Evaluation of liver transplantation for high-risk indications.
abstract: BACKGROUND
  Appropriate use of orthotopic liver transplantation (OLT) requires 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 recurrent disease (patients with tumours, hepatitis B- or hepatitis C-induced 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 per cent respectively. The overall survival rate of high-risk patients was significantly lower than that for all OLT recipients (P < 0.05). While no patients transplanted for hepatitis C have developed graft failure, recurrent hepatitis occurred in 15 of 35 patients.
  
  
  CONCLUSIONS
  Strict selection criteria and appropriate perioperative investigations and interventions are required to improve the results of OLT in these high-risk patients.
authors.affiliation: Department of Surgery, Toronto Hospital, University of Toronto, Canada.
authors.forename: S W
authors.initials: SW
authors.lastname: Chung
authors.forename: P D
authors.initials: PD
authors.lastname: Greig
authors.forename: M S
authors.initials: MS
authors.lastname: Cattral
authors.forename: B R
authors.initials: BR
authors.lastname: Taylor
authors.forename: P A
authors.initials: PA
authors.lastname: Sheiner
authors.forename: I
authors.initials: I
authors.lastname: Wanless
authors.forename: R
authors.initials: R
authors.lastname: Cameron
authors.forename: M J
authors.initials: MJ
authors.lastname: Phillips
authors.forename: L M
authors.initials: LM
authors.lastname: Blendis
authors.forename: B
authors.initials: B
authors.lastname: Langer
authors.forename: G A
authors.initials: GA
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006085:Graft Survival; D006501:Hepatic Encephalopathy / Q000601:surgery*; D006509:Hepatitis B / Q000601:surgery*; D006526:Hepatitis C / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors