From 21st of april 1978 to 1st september 1994, 200
liver transplantations in 172 patients were performed in the Medical Center of University of Rennes. Three patients had a liver and kidney transplant. 26 patients received a second transplant (13%) and 2 patients a third transplant (1%). There were 110 males and 62 females with a mean age of 43.7 years (range 17 months-66 years). The indications of
transplantations were the following: 22
fulminant hepatitis (12%), 104
cirrhosis (60.5%), including 41
alcoholic cirrhosis (24%), 21 post-
hepatitis B cirrhosis (12.2%), 24 post-
hepatitis C cirrhosis (14%), 6 autoimmune
cirrhosis, 7
primary biliary cirrhosis (4%), 21 non A non B
cirrhosis (12.9%), 3 undetermined
cirrhosis. Thirty one patients had a
liver transplantation for
cancer. The other indications were 5
sclerosing cholangitis and 2 atresia of the biliary tract. 45% of the patients had an uneventful postoperative course. In hospital mortality rate is related to the indication and Child Pugh classification in cirrhotic patients. The vascular surgical complications were 8.5%, biliary complications 6.1%,
intra-abdominal infection 9.2%, intra-abdominal
bleeding 5.5%. The rate of reoperation was 18.5%. 23 re-
transplantations were performed in emergency and 6 electively (one from outside). The overall survival of patients from 1978 to 1994, including the patients before
cyclosporine era, the use of
extracorporeal circulation, the preservation with Wisconsin solutions and with main indications for
cancer was 69% at 1 year and 59% at 5 years. After 1988, the overall patient survival was 75% at 1 year and 70% at 5 years. The graft and patient survival is mainly related to the indications. In fulminant and subfulminant
hepatitis, the quality of the graft was preferred as often as possible. The actuarial graft survival at 1 year, 3 years and 5 years was respectively 75%, 70.45% and 70.45%. The actuarial patient survival was 77.3%, 72.5% and 72.5%. In
liver transplantation for
cancer, the actuarial patient survival at 1 year, 3 years and 5 years is respectively 55%, 32% and 23.5%. 5 patients are alive and well at 5 years, including a patient who underwent a Cluster operation for
Klatskin tumor. In post-
hepatitis cirrhosis, the patient actuarial survival at 1 year, 3 years and 5 years was 79%, 76.5% and 76.5% and in
alcoholic cirrhosis 75%, 72% and 72%. The actuarial survival is closely related to Child Pugh Classification (at one year Child A 87%, Child B 72.4%, Child C 58%).
CONCLUSION: in this series of the first 200
liver transplants at the University of Rennes Medical Center, graft and patient survival depends on the evolution of the surgical technic but it is also closely related to the indication. In
fulminant hepatitis, the quality of the graft (without incompatible graft, if possible) should permit to avoid retransplantation and to obtain results closely to the elective
transplantation.
Liver transplantation for
cancer should be restricted. In
cirrhosis, results are depending upon Child Pugh classification. The conclusions of Paris consensus conference should be followed. The limited number of donor livers call for the "priorization" (T.E. Starzl) favoring those patients who will benefit most, i.e., patients with the most serious conditions and the poorest short term vital prognosis.