Orthotopic liver transplantation: report of 70 cases

OBJECTIVES: To summarize the results of liver transplantation for various end-stage liver diseases at Sun Yat-sen University of Medical Sciences, define the role of liver transplantation in treatment of hepatocellular carcinoma (HCC) and fulminant hepatitis B, and assess the value of lamivudine for preventing HBV recurrence. METHODS: Clinical data of seventy patients undergoing orthotopic liver transplantation (OLT) at Sun Yat-sen University of Medical Sciences between April 1993 and December 2000 were retrospectively analyzed. The main indications for liver transplantation were HCC (26 cases), liver cirrhosis (21), fulminant hepatitis B (12), sclerosing cholangitis (4) and other terminal liver diseases (7). Lamivudine was used in 12 patients with fulminant hepatitis B. Logistic multivariate regression analysis was employed to determine the risk factors predicting outcome of liver transplantation. RESULTS: Fifty-four patients survived for more than one month and 16 patients died within 30 days after OLT. The overall hospital survival rate was 77.1%. The hospital survival rates in Child's A and B patients were 87.5% and 83.3%, respectively. They were superior to those of the Child's C patients (P < 0.05). The outcome of patients with small HCC was superior to that of patients with large HCC. Preoperative APACE III scores, the severity of ascites, and serum creatine level had an independent influence on outcome. Of the patients with fulminant HBV infection, 9 survived for 2-24 months. Treatment with lamivudine monotherapy was both well tolerated and efficacious in patients with fulminant Hepatitis B. CONCLUSIONS: OLT can cure some patients and provide palliation for others with HCC. Patient selection is extremely important for predicting outcome. The results support the application of liver transplantation as a therapeutic modality for various end-stage liver diseases. Lamivudine is effective and safe in OLT for patients with HBV infection.