Fifteen-year experience with adult and pediatric liver transplantation at the University of California, Los Angeles.
In the past 6 years, advances in surgical technique and immunosuppression regimens have improved overall survival of transplant patients. Hepatitis C and alcoholic cirrhosis are the most common indications for transplantation at this center in the adult population while biliary atresia remains the most common indication in children. Organ shortages remain the most formidable obstacle to widespread application of organ transplantation. As recipient indications and criteria for transplantation expand, the number of patients awaiting organs increases. Simultaneously, donor criteria has not expanded and overall donor numbers have not increased substantially. We have used several approaches to alleviate the shortage of organs for both adults and children. Living-related donor transplantation yields excellent results and the operation can be done in an elective setting; however, it places an otherwise healthy person at risk. It is justified on basis of good results and the present shortage of organs. In-situ split-liver transplantation presents the opportunity to transplant children with size-matched organs without reducing the adult cadaveric pool. It is limited by the technical expertise required to perform the procedure safely. It can reduce the need to resort to living donor transplantation and is routinely used as the first option for pediatric patients awaiting transplantation at UCLA. Our results show that good results can be achieved with strict donor and recipient selection. In situ splitting has had a substantial impact on decreasing the pediatric waiting list time at our institution. Small bowel transplantation results have been improving; however, the complications related to the heavy immunosuppressive regimens need to be resolved.
Amersi
F
F
Department of Surgery, Liver and Pancreas Transplantation, University of California, Los Angeles, USA.
Farmer
D G
DG
Busuttil
R W
RW
D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D006085:Graft Survival; D006498:Hepatectomy; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007421:Intestine, Small / Q000637:transplantation*; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data*; D019520:Living Donors / Q000706:statistics & numerical data; D015141:Los Angeles; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors / Q000706:statistics & numerical data; D020858:Tissue and Organ Harvesting / Q000379:methods; D014184:Transplantation, Homologous / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data*