Survival after liver transplantation for primary biliary cirrhosis: use of prognostic indices for comparison with medical treatment.
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Biomedical subjects
Publications and source records attributed to B G Ericzon.
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The utility of bile cytology (BC) in the diagnosis of hepatic graft rejection was assessed in 21 liver transplantations in 18 patients. A total of 307 BC specimens were studied; cell density and relative contribution of different cell types were monitored in 130 specimens. The findings in 62 fine-needle aspiration biopsies and 9 core needle biopsies (CNB) from the transplants were compared with those of the BC specimens. For the first 3-5 days after transplantation, BC specimens were cell-rich, containing degenerating cells and polymorphonuclear leukocytes. In uneventful cases, the cellularity of the specimens gradually decreased. Upon rejection, the number of cells increased, with a high percentage of PMN. Occasionally, blasts or macrophages were detected. After antirejection treatment, the cellularity of the specimens decreased. The analysis of the relationship between the findings of BC and FNAB showed that a high cell density was indicative of rejection. However, BC was not as sensitive to rejection as was FNAB. No clear-cut correlation was found between BC pattern and the degree of cell infiltration in portal triads as seen in CNB specimens. Our results indicate that serial bile cytology is valuable as an additional diagnostic method in monitoring hepatic graft rejection.
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At the 32 European centres where livers are transplanted the actuarial survival rate for 1218 patients was 44% at 1 year and 41% at 2 years. Perioperative mortality (30 days) was 30%. Recipients aged under 15 years had a higher survival rate than those aged over 15; the differences were 22% at 1 year and 32% at 2 years. For the 97 patients who received two or more liver grafts, actuarial survival was 27.7% at 1 and 2 years. Two-thirds of the transplantations were done since 1984. Since then the best results have been obtained for biliary atresia (88 cases; survival rates at 30 days, 1 year, and 2 years were 87%, 74%, and 68%). Primary biliary cirrhosis was the commonest benign indication for transplantation, with survival of 64% at 1 and 2 years. The proportion of transplantations that were done for patients with hepatocellular carcinoma was smaller after than before 1984; among transplantations done in adults after 1984, those done because of hepatocellular carcinoma gave the best perioperative survival rate (76%) but the worst 2 year survival (30.8%).
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A venovenous bypass for transplantation of the liver was developed and evaluated in dogs and applied clinically, with flows that averaged less than 500 milliliters per minute. Fatal pulmonary emboli were seen in two of 40 experiments. The venovenous flow in the four pediatric recipients was 200 to 1,200 milliliters per minute, and there were no complications.
Orthotopic liver transplantation was performed in two groups of dogs; Group I animals consisted of large dogs that served as recipients of livers obtained from smaller dogs while Group II animals consisted of dogs that received liver from donor dogs of nearly the same size. The small-for-size livers transplanted into the Group I dogs rapidly increased in size over the course of 2 weeks until they achieved a size equal to that originally present in the larger recipient dogs. In contrast, the livers transplanted into dogs of the same size as the donors underwent some degree of atrophy. In both groups of animals, plasma levels of insulin and glucagon and hepatic (graft) activities of thymidine kinase and ornithine decarboxylase were followed serially. The only difference between the two groups of animals for these measures was that the ornithine decarboxylase activity rose to a greater degree in the liver that underwent graft enlargement. These data suggest that recipient size determines, at least in part, liver graft size once it is transplanted. These data also suggest that of the parameters followed, only ornithine decarboxylase activity parallels the finding of growth of the transplanted liver.