The first one thousand liver transplants in Turin: a single-center experience in Italy.
The first Italian liver transplant center to reach the goal of 1000 procedures was Turin. The paper reports this single-center experience, highlighting the main changes that have occurred over time. From 1990 to 2002, 1000 consecutive liver transplants were performed in 910 patients, mainly cirrhotics. Surgical technique was based on the preservation of the retrohepatic vena cava of the recipient. The veno-venous bypass was used in 30 cases only and abandoned since 1997. Operating time, warm ischemia time and length of hospital stay significantly decreased over the years, while operating room extubation became routine. Immunosuppression pivoted on cyclosporine A. Management of retransplantations, marginal grafts, and of HCV-positive, HBV-positive and hepatocellular carcinoma recipients were optimized. Median follow-up of the patients was 41 months. Overall survival rates at 1, 5 and 10 years were 87%, 78% and 72% respectively. Survival rates obtained in the second half of the cases (1999-2002 period) were significantly better than those obtained in the first half (1990-1998 period) (90% vs. 83% at 1 year and 81% vs. 76% at 5 years respectively). Increasing experience in liver transplant surgery and postoperative care allowed standardization of the procedure and expansion of the activity, with parallel improvement of the results.
Salizzoni
Mauro
M
Liver Transplantation Center, San Giovanni Battista Hospital, Turin, Italy. msalizzoni@molinette.piemonte.it
Cerutti
Elisabetta
E
Romagnoli
Renato
R
Lupo
Francesco
F
Franchello
Alessandro
A
Zamboni
Fausto
F
Gennari
Fabrizio
F
Strignano
Paolo
P
Ricchiuti
Alessandro
A
Brunati
Andrea
A
Schellino
Maria Maddalena
MM
Ottobrelli
Antonio
A
Marzano
Alfredo
A
Lavezzo
Bruna
B
David
Ezio
E
Rizzetto
Mario
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000494:pharmacology / Q000627:therapeutic use; D005355:Fibrosis / Q000628:therapy; D006085:Graft Survival; D016174:Hepacivirus / Q000235:genetics; D006509:Hepatitis B / Q000821:virology; D006515:Hepatitis B virus / Q000235:genetics; D006526:Hepatitis C / Q000821:virology; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007558:Italy; D008113:Liver Neoplasms / Q000628:therapy; D016031:Liver Transplantation / Q000379:methods*; D008875:Middle Aged; D015233:Models, Statistical; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016572:Cyclosporine