In recent years, growing up of clinical experience, intensive care facilities and beter understanding of immunobiology of transplantation has lead to an increament of utilization of living and marginal donors with better patient and graft survival rates. In this study we evaluated the beneficial effects of increasing institutional experience on the outcome of patients undergone liver transplantation at our department.
Between February 1997 - August 2004, 68 liver transplantation was performed at our center. 11 patients were in the pediatric age group and 57 patients were adults. Living and cadaveric donors were used in 27 and 41 patients respectively. The indications for transplantation in pediatric age group were biliary atresia in 5, Wilson disease in 3 (one case presented with a fulminant couse), primary hyperoxaluria in 1 (together with real time renal transplantation from living donor), hepatoblastoma in 1 and autoimmune hepatitis in 1 patients. In adult patients, etiologies of liver disease were mostly hepatitis B, C, alcoholihism, autoimmune hepatitis, and Caroli Disease. In our adult age group 4 patients with HBV, 3 patients with HCV and 1 patient with cirrhosis caused by alcohol had hepatocellular carcinoma. Survival rate in the first 24 patients was 37.5%. Perioperative mortality was observed in 11 patients and , 4 patients were died 2-11 months after surgery. However, the survival rate in the last 44 patients was 90.9%. 3 patients were lost in perioperative period and 1 at 11 months after surgery due to the recurrence of hepatoblastoma. (log rank=20.7, p=0.00001). No mortality was observed after the first year of transplantation in surviving patients in both groups. In conclusion. there is an institutional learning curve for liver transplantation. Improvement of experience and survival rate necessitates multidisciplinary approach, effort and continuity of patient flow.