Liver transplantation at the University of Pittsburgh, 1984 to 1990

Abstract

Patient and primary graft survival for 2,090 patients who received primary liver transplants at the University of Pittsburgh from 1984 through 1990 are presented. Observed (actual) 3- and 12-month patient and primary graft survival rates were compared for 3 periods: 1) January 1984 to September 1987 (cyclosporine, OKT3, and Euro-Collins preservation period); 2) October 1987 to December 1988 (University of Wisconsin solution preservation period); and 3) January 1989 to December 1990 (FK506 period). Data for results according to age group, medical urgency, and primary diagnosis are provided. In addition, estimated survivor and cumulative hazard functions (life-table method) for patient and primary graft survival out to 60 months after transplantation are presented. Overall results have improved significantly in recent experience. Most notable are the improved results seen in liver transplantation for patients with biliary atresia (especially in infants), primary sclerosing cholangitis, fulminant hepatic failure, and chronic active hepatitis B. For all but a few conditions, most of the mortality after liver transplantation occurred in the first 3 months after surgery. Less than 2% of patients were lost in each 6-month interval beyond the first 6 months after transplantation. Outcome was related to patient condition at the time of surgery. Observed survival rates at 3 and 12 months for patients called in the hospital to receive a transplant were 88.6% and 86.5%, respectively, compared with 81.9% and 73.7% for patients in critical condition. The continuing shortage of organs for transplantation, which often forces patients to wait longer for an organ than they can afford to, continues to impose a significant penalty.

Figure 1

Comparison of 3- and 12-month observed (actual) and actuarial (life-table method) patient and primary graft survival rates. Since there is complete follow-up and all patients were followed for at least one year, the survival rates determined by the two methods are the same.

Figure 2

Left: Estimated survivor function (life-table method) for patient survival according to time period during which transplantation was performed. Right: Cumulative hazard function for patient survival by time period.

Figure 3

Left: Estimated survivor function (life-table method) for primary graft survival according to time period during which transplantation was performed. Right: Cumulative hazard function for primary graft survival by time period.

Figure 4

Left: Estimated survivor function (life-table method) for patient survival according to age group during which transplantation was performed. Right: Cumulative hazard function for primary graft survival by age group.

Figure 5

Left: Estimated survivor function (life-table method) for primary survival according to age group. Right: Cumulative hazard function for primary graft survival by age group.

Figure 6

Left: Estimated survivor function (Kaplan-Meier method) for patient survival according to body weight. Right: Cumulative hazard function for patient survival by age group.

Figure 7

Left: Estimated survivor function (life-table method) for patient survival according to medical urgency at the time of transplantation. Right: Cumulative hazard function for patient survival according to medical urgency.

Figure 8

Left: Estimated survivor function (life-table method) for patient survival for liver recipients receiving transplants for postnecrotic cirrhosis (excluding HBsAg+ patients), adult cholestatic diseases (primary biliary cirrhosis or primary sclerosing. cholangitis), biliary atresia, and alcoholic cirrhosis. Right: Cumulative hazard function for patient survival for these primary liver conditions.

Figure 9

Left: Estimated survivor function (life-table method) for primary graft survival for liver recipients receiving transplants for postnecrotic cirrhosis (excluding HBsAg+ patients), adult cholestatic diseases (primary biliary cirrhosis or primary sclerosing. cholangitis), biliary atresia, and alcoholic cirrhosis. Right: Cumulative hazard function for primary graft survival for these primary liver conditions.

Figure 10

Left: Estimated survivor function (life-table method) for patient survival for liver recipients receiving transplants for fulminant hepatic failure, chronic active hepatitis B (HBsAg+ patients), and primary liver cancer. Right: Cumulative hazard function for patient survival for these primary liver conditions.

Figure 11

Left: Estimated survivor function (life-table method) for primary graft survival for liver recipients receiving transplants for fulminant hepatic failure, chronic active hepatitis B (HBsAg+ patients), and primary liver cancer. Right: Cumulative hazard function for primary graft survival for these primary liver conditions.