The paper reports this Iranian single center experience, highlighting main changes that have occurred over time.
Methods: Between April 1993 and June 2006, 250 liver transplantations were performed on 247 cirrhotic patients, at Shiraz organ transplantation, the single center for liver transplantation in Iran. Surgical technique was based on preservation of retrohepatic vena cava (Piggy-Back) of recipient. We excluded the 1st fifty cases to dismiss the effect of ‘’learning curve’’. During the period of high volume procedures (March 2002–June 2006), twohundred consecutive liver transplantations were studied, respectively by comparing the 1st one-hundred (group 1) with the second (group 2). The mean follow-up was 21.9+/-14 months (CI_95%: 19-24) for group 1 and 7.0 +/- 5.3 (CI_95%: 5.9-8.1) for group 2. Survival rates were calculated by Kaplan-Meier test. The characteristics of donors and recipients including age, sex, indication for liver transplantation, Child-Pugh score, and blood group were not statistically different. Early mortality was 18% in the first group v/s 9% in the second (p=0.107). ICU stay was 4.7+/- 3.7 v/s 4.5+/- 3.1 days (P=0.76). Reoperations were the same (14) in both groups. Clinical rejection occurred in 52% v/s 47% (P=0.76). Renal failure was found in 4% v/s 1% (P=0.36). Biliary leak occurred in 12% v/s 5 % (P=0.12). Significant improvements were found in hospital stay (27.4+/- 17.2 v/s 22.6 +/- 14.3 days, P=0.03), 3–month patient survival (72% vs 85%, P=0.04), and one-year survival (72% vs 83.8% in 37 patients of second group who had 1-year follow-up, P=0.021). Increasing experience in liver transplantation, refinement of surgical technique, improved organ procurement, and post-op care allowed standardization of the procedure and expansion of the activity, with parallel improvement of the results. Despite we achieved excellent results, we hope to reach better survival rates (over 90%) in near future.