One thousand liver transplants: The lessons learned

R. W. Busuttil, A. Shaked, J. M. Millis, O. Jurim, Steven D Colquhoun, C. R. Shackleton, B. J. Nuesse, M. Csete, L. I. Goldstein, S. V. McDiarmid, W. C. Meyers, J. C. McDonald, A. G. Diethelm

Research output: Contribution to journalArticle

126 Citations (Scopus)

Abstract

Objective. To evaluate the first 1000 liver transplants performed at UCLA Medical Center to determine factors responsible for improved results. Summary Background Data. Liver transplant has evolved impressively since the first case was performed in 1963. The 1980s have highlighted this progress with the development of better organ preservation, standardization of operative procedure, improved immunosuppressive agents, and better understanding of patient selection. Methods. The first 100 consecutive liver transplants (group 1) performed from February 1984 through October 1986 were compared with the last 200 (group 2) performed between September 1991 and June 1992. An analysis was made of donor use; changes in patient candidacy; patient care variables; morbidity and mortality; survival data; and hospital resource use. Results. In groups 1, 31% of donors were refused because of medical unsuitability compared with 4% in group 2 (p <0.0001). In group 1, alcoholic patients comprised 1% of liver transplant candidates compared with 20% group 2 (p < 0.0001). High risk patients (United Network for Organ Sharing criteria 4) only comprised 11% of patients in group 1 compared with 37% in group 2 (p < 0.0001). Operative time (7.6 hours compared with 5.4 hours), packed cell replacement (17 units compared with 9.5 units), intensive care unit stay (10 days compared with 5 days), and hospital stay (50 days compared with 31 days) were all significantly improved (p < 0.05). In group 1, the 1-year survival rate was 73% and improved to 88% in group 2 (p < 0.0001). Conclusions. Despite unfavorable donor characteristics (obesity, cause of death, age hypotension), most organs function well and should not be refused based on history alone. The older and high-risk patient (renal failure, ventilator dependence, portal vein pathology, and so on) is routinely transplanted with good success. Despite liberalization of both donor and recipient criteria, patient survival after liver transplant is improved, use of hospital resources is maximized, and cost reduction is achieved.

Original languageEnglish (US)
Pages (from-to)490-499
Number of pages10
JournalAnnals of Surgery
Volume219
Issue number5
DOIs
StatePublished - Jan 1 1994
Externally publishedYes

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Transplants
Liver
Tissue Donors
Organ Preservation
Survival
Operative Surgical Procedures
Mechanical Ventilators
Alcoholics
Immunosuppressive Agents
Operative Time
Portal Vein
Hypotension
Patient Selection
Renal Insufficiency
Intensive Care Units
Cause of Death
Length of Stay
Patient Care
Survival Rate
Obesity

ASJC Scopus subject areas

  • Surgery

Cite this

Busuttil, R. W., Shaked, A., Millis, J. M., Jurim, O., Colquhoun, S. D., Shackleton, C. R., ... Diethelm, A. G. (1994). One thousand liver transplants: The lessons learned. Annals of Surgery, 219(5), 490-499. https://doi.org/10.1097/00000658-199405000-00007

One thousand liver transplants : The lessons learned. / Busuttil, R. W.; Shaked, A.; Millis, J. M.; Jurim, O.; Colquhoun, Steven D; Shackleton, C. R.; Nuesse, B. J.; Csete, M.; Goldstein, L. I.; McDiarmid, S. V.; Meyers, W. C.; McDonald, J. C.; Diethelm, A. G.

In: Annals of Surgery, Vol. 219, No. 5, 01.01.1994, p. 490-499.

Research output: Contribution to journalArticle

Busuttil, RW, Shaked, A, Millis, JM, Jurim, O, Colquhoun, SD, Shackleton, CR, Nuesse, BJ, Csete, M, Goldstein, LI, McDiarmid, SV, Meyers, WC, McDonald, JC & Diethelm, AG 1994, 'One thousand liver transplants: The lessons learned', Annals of Surgery, vol. 219, no. 5, pp. 490-499. https://doi.org/10.1097/00000658-199405000-00007
Busuttil RW, Shaked A, Millis JM, Jurim O, Colquhoun SD, Shackleton CR et al. One thousand liver transplants: The lessons learned. Annals of Surgery. 1994 Jan 1;219(5):490-499. https://doi.org/10.1097/00000658-199405000-00007
Busuttil, R. W. ; Shaked, A. ; Millis, J. M. ; Jurim, O. ; Colquhoun, Steven D ; Shackleton, C. R. ; Nuesse, B. J. ; Csete, M. ; Goldstein, L. I. ; McDiarmid, S. V. ; Meyers, W. C. ; McDonald, J. C. ; Diethelm, A. G. / One thousand liver transplants : The lessons learned. In: Annals of Surgery. 1994 ; Vol. 219, No. 5. pp. 490-499.
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abstract = "Objective. To evaluate the first 1000 liver transplants performed at UCLA Medical Center to determine factors responsible for improved results. Summary Background Data. Liver transplant has evolved impressively since the first case was performed in 1963. The 1980s have highlighted this progress with the development of better organ preservation, standardization of operative procedure, improved immunosuppressive agents, and better understanding of patient selection. Methods. The first 100 consecutive liver transplants (group 1) performed from February 1984 through October 1986 were compared with the last 200 (group 2) performed between September 1991 and June 1992. An analysis was made of donor use; changes in patient candidacy; patient care variables; morbidity and mortality; survival data; and hospital resource use. Results. In groups 1, 31{\%} of donors were refused because of medical unsuitability compared with 4{\%} in group 2 (p <0.0001). In group 1, alcoholic patients comprised 1{\%} of liver transplant candidates compared with 20{\%} group 2 (p < 0.0001). High risk patients (United Network for Organ Sharing criteria 4) only comprised 11{\%} of patients in group 1 compared with 37{\%} in group 2 (p < 0.0001). Operative time (7.6 hours compared with 5.4 hours), packed cell replacement (17 units compared with 9.5 units), intensive care unit stay (10 days compared with 5 days), and hospital stay (50 days compared with 31 days) were all significantly improved (p < 0.05). In group 1, the 1-year survival rate was 73{\%} and improved to 88{\%} in group 2 (p < 0.0001). Conclusions. Despite unfavorable donor characteristics (obesity, cause of death, age hypotension), most organs function well and should not be refused based on history alone. The older and high-risk patient (renal failure, ventilator dependence, portal vein pathology, and so on) is routinely transplanted with good success. Despite liberalization of both donor and recipient criteria, patient survival after liver transplant is improved, use of hospital resources is maximized, and cost reduction is achieved.",
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AU - Colquhoun, Steven D

AU - Shackleton, C. R.

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N2 - Objective. To evaluate the first 1000 liver transplants performed at UCLA Medical Center to determine factors responsible for improved results. Summary Background Data. Liver transplant has evolved impressively since the first case was performed in 1963. The 1980s have highlighted this progress with the development of better organ preservation, standardization of operative procedure, improved immunosuppressive agents, and better understanding of patient selection. Methods. The first 100 consecutive liver transplants (group 1) performed from February 1984 through October 1986 were compared with the last 200 (group 2) performed between September 1991 and June 1992. An analysis was made of donor use; changes in patient candidacy; patient care variables; morbidity and mortality; survival data; and hospital resource use. Results. In groups 1, 31% of donors were refused because of medical unsuitability compared with 4% in group 2 (p <0.0001). In group 1, alcoholic patients comprised 1% of liver transplant candidates compared with 20% group 2 (p < 0.0001). High risk patients (United Network for Organ Sharing criteria 4) only comprised 11% of patients in group 1 compared with 37% in group 2 (p < 0.0001). Operative time (7.6 hours compared with 5.4 hours), packed cell replacement (17 units compared with 9.5 units), intensive care unit stay (10 days compared with 5 days), and hospital stay (50 days compared with 31 days) were all significantly improved (p < 0.05). In group 1, the 1-year survival rate was 73% and improved to 88% in group 2 (p < 0.0001). Conclusions. Despite unfavorable donor characteristics (obesity, cause of death, age hypotension), most organs function well and should not be refused based on history alone. The older and high-risk patient (renal failure, ventilator dependence, portal vein pathology, and so on) is routinely transplanted with good success. Despite liberalization of both donor and recipient criteria, patient survival after liver transplant is improved, use of hospital resources is maximized, and cost reduction is achieved.

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