title: Patient outcomes in a liver transplant program in Iran.
abstract: OBJECTIVE
  The first liver transplant program in Tehran was started at Tehran University of Medical Sciences in 2002. The purpose of this study was to evaluate patient outcomes in this program.
  
  
  METHODS
  From January 2002 to February 2013, there were 172 deceased-donor orthotopic liver transplants performed in 166 patients, including revision transplant in 6 patients. Outcomes were evaluated for 4 phases of the program: (1) phase 1 (2002 to 2005; 9 transplants); (2) phase 2 (2006 to 2009; 41 transplants); (3) phase 3 (2010 to 2011; 49 transplants); and (4) phase 4 (2012 to 2013; 73 transplants).
  
  
  RESULTS
  The most frequent indications for liver transplant included cryptogenic cirrhosis, autoimmune hepatitis, and hepatitis B and C cirrhosis. During the progression from phase 1 to 4, there were significant decreases in median cold ischemia time, operative time, and transfusions (platelets, packed red blood cells, and fresh frozen plasma). The most frequent complications included infection and acute rejection. The overall median follow-up for all patients was 26 months (range, 9-144 mo). Frequency of 1-month, 3-month, 1-year, and 2-year survival increased from phase 1 to 4. Kaplan-Meier plots showed significant improvement in patient survival from phase 1 to 4 (P ≤ .001). The most common causes of death were sepsis and bleeding.
  
  
  CONCLUSIONS
  Clinical outcomes with deceased-donor liver transplant may be improved with a cooperative multidisciplinary team, coordinated care from different specialties, increased experience, and modifications of anesthetic and surgical techniques. Comprehensive unified written protocols for preoperative, perioperative, and postoperative treatment may help improve outcomes after sufficient experience is achieved.
authors.affiliation: Department of General Surgery, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Jafarian
authors.forename: Amir
authors.initials: A
authors.lastname: Kasraianfard
authors.forename: Atabak
authors.initials: A
authors.lastname: Najafi
authors.forename: Javad
authors.initials: J
authors.lastname: Salimi
authors.forename: Majid
authors.initials: M
authors.lastname: Moini
authors.forename: Farid
authors.initials: F
authors.lastname: Azmoudeh-Ardalan
authors.forename: Zahra
authors.initials: Z
authors.lastname: Ahmadinejad
authors.forename: Setareh
authors.initials: S
authors.lastname: Davoudi
authors.forename: Roya
authors.initials: R
authors.lastname: Sattarzadeh
authors.forename: Sepideh
authors.initials: S
authors.lastname: Seifi
authors.forename: Reza Shariat
authors.initials: RS
authors.lastname: Moharari
authors.forename: Ali
authors.initials: A
authors.lastname: Nejatisafa
authors.forename: Hazhir
authors.initials: H
authors.lastname: Saberi
authors.forename: Ali
authors.initials: A
authors.lastname: Aminian
authors.forename: Ali Reza
authors.initials: AR
authors.lastname: Kazemeini
authors.forename: Nasir
authors.initials: N
authors.lastname: Fakhar
authors.forename: Jalil
authors.initials: J
authors.lastname: Makarem
authors.forename: Niloufar Ayoubi
authors.initials: NA
authors.lastname: Yazdi
authors.forename: Amir Ali
authors.initials: AA
authors.lastname: Sohrabpour
authors.forename: Habib
authors.initials: H
authors.lastname: Dashti
authors.forename: Mohssen
authors.initials: M
authors.lastname: Nassiri-Toosi
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality; D006801:Humans; D007492:Iran; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality; D015397:Program Evaluation; D016016:Proportional Hazards Models; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult