Survival and rehabilitation after orthotopic liver transplantation.

Between May, 1968, and April 27, 1980, 94 patients have been treated by orthotopic liver transplantation. During this time operative techniques and the management and selection of patients have changed. Healing of the biliary-tract anastomoses has been better since the introduction of a gallbladder conduit procedure and early irrigation of the donor biliary tract largely prevents damage to biliary-tract mucosa and sludge formation. Partial cardiopulmonary bypass in selected cases can provide control of the circulation during surgery. Many patients have been operated on too late, and an earlier selection is indicated. Of the 94 patients, 18 lived for over one year and 11 for two years, with 2 surviving for more than five years. 13 patients are currently alive. Rehabilitation of long-term survivors has been excellent, and although tumour recurred in more than 60% of patients grafted for primary hepatoma, worthwhile palliation can still be achieved.