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Indications for liver transplantation in the cyclosporine era

Gordon, RD and Shaw, BW and Iwatsuki, S and Esquivel, CO and Starzl, TE (1986) Indications for liver transplantation in the cyclosporine era. In: UNSPECIFIED.

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Abstract

One hundred seventy orthotopic liver transplants were performed under conventional immunosuppression with azathioprine and steroids with 1- and 5-year survivals of 32.9% and 20.0%, respectively. Since the introduction of cyclosporine-prednisone therapy in March 1980, 313 primary orthotopic liver transplants have been performed. Actuarial survivals at 1 and 5 years have improved to 69.7% and 62.8%, respectively. Biliary atresia is now the most common indication for liver replacement. In adults, primary biliary cirrhosis and sclerosing cholangitis have become more common indications for transplantation, and alcoholic cirrhosis and primary liver malignancy as indications have declined. Early enthusiasm for liver transplantation in patients with hepatic cancer has been tempered by the finding that recurrence is both common and rapid. An increasing number of patients with inborn errors of metabolism originating in the liver are receiving transplants, including patients with Wilson's disease, tyrosinemia, alpha-1-antitrypsin deficiency, glycogen storage disease, familial hypercholesterolemia, and hemochromatosis. Survival in this group of patients has been excellent (74.4% at 1 and 5 years). A hemophiliac who received a transplant for postnecrotic cirrhosis has survived and may have been cured of his hemophilia. About 20% of patients require retransplantation for rejection, technical failure, or primary graft failure. Only 4 of the patients receiving retransplants under conventional immunosuppression survived beyond 6 months, and all died within 14 months of retransplantation. Sixty-eight patients have received retransplants under cyclosporine-prednisone. Thirty-one patients are surviving, all for at least 1 year. Six of the 12 patients requiring a third transplant are alive 2 to 3 years after the primary operation. An aggressive approach to retransplantation in the patient with a failed graft is justified.


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Details

Item Type: Conference or Workshop Item (UNSPECIFIED)
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Gordon, RD
Shaw, BW
Iwatsuki, S
Esquivel, CO
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 January 1986
Date Type: Publication
Journal or Publication Title: Surgical Clinics of North America
Volume: 66
Number: 3
Page Range: 541 - 556
DOI or Unique Handle: 10.1016/s0039-6109(16)43939-3
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0039-6109
Other ID: uls-drl:31735062116003, Starzl CV No. 634
Date Deposited: 08 Apr 2010 17:10
Last Modified: 14 Oct 2017 11:55
URI: http://d-scholarship.pitt.edu/id/eprint/4020

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