Background: One of Dr Starzl’s early transplant fellows in Denver, CO was Dr Ruud Krom from the Netherlands. Dr Krom returned to his homeland and established a liver transplant program in Groningen. The results were excellent, even without the availability of calcineurin inhibitors, and Dr Krom was recruited to the Mayo Clinic in Rochester, MN in 1985 where he established a second successful program. I was a transplant surgical fellow at Mayo from 1986 and was on staff at Mayo until 1997 when I returned to set up a liver transplant unit in Auckland, New Zealand (NZ). The population of NZ is only 4.2 million and there is only one liver transplant unit located at Auckland City Hospital.

Materials and Methods: The NZ Liver Transplant Unit database was reviewed and the data collected on the first 514 patients was collated for this report. The period of time over which these transplants were performed was from February 1998 to December 2012. Descriptive statistics were used to describe patient demographics and outcomes.

Results: 922 adult and paediatric patients were assessed for transplantation of which 680 (74%) were listed. Of these 514 (76%) were transplanted, 22 (3%) were waiting and 144 (21%) were delisted (105 [73%] for deterioration). Most patients received deceased donor livers but 12.5% received living donor liver segments. Adults were transplanted most frequently for viral hepatitis (HBV and HCV) with or without hepatocellular carcinoma and most children were transplanted for biliary atresia. Transplant procedures have taken an average of 6 hours and average length of hospital stay has been 14 days for adults and 25 days for children. Overall patient survival following liver transplantation at 1, 5 and 10 years is 96%, 89% and 81%. Re-transplantation has been required in 3.4% of patients. Average waiting time for a transplant has increased from 44 days in 1998 to 213 days in 2012. This is a result of the growing waiting list and a shortage of deceased donor organs. NZ has, on average, only 10 deceased donors per million of population per year which presents a significant challenge given the demand for organs. NZ has a socialized medical system and therefore all the costs associated with the transplant including patient assessment, transport, accommodation, transplant surgery, post-transplant cares (including immunosuppressive drugs) are covered by public health funding.

Summary: The important Hippocratic principle of training younger doctors has been applied in the liver transplant arena. The world-wide influence of Dr Tom Starzl’s pioneering efforts continues to be seen, even at the ‘ends of the earth’. Excellent results can be achieved even in small volume liver transplant programs provided careful attention is given to both surgical and medical details as advocated by Dr Starzl.