부산대학교 도서관

Before 1987, there was no regional liver transplant service available to the 10 million people of the Pacific Northwest. In 1987 a liver transplantation program was established as a joint project of the Oregon Health Sciences University and the Portland Veterans Affairs Medical Center. The results of the first two years of operation are presented. There were 94 patients evaluated within the first two years of operation, and 47 adults underwent 54 liver transplantations (seven patients had a second liver transplant). The average patient age was 44 years, and 72 percent were men. Veterans accounted for 34 percent of the patients treated. The average operation lasted 7.4 hours, and the average hospital stay was 30 days. There were 15 biliary (gallbladder-related) complications, for a rate of 28 percent. One patient died (2 percent mortality) within the post-surgery period (the month following surgery). At one year, the survival rate was 80 percent. Patients with hepatitis B had the poorest outcome; four of six patients died after an average of 7.6 months. The overall rate of organ rejection was 55 percent. The reasons for failure of a transplantation were a nonfunctioning donor organ (three patients), uncontrolled organ rejection (two patients), and recurrence of hepatitis B (two patients). Of 25 patients able to be interviewed with regard to quality of life, 18 (72 percent) were able to perform their usual daily activities and work. An additional four patients were able to care for themselves and work part-time. (Consumer Summary produced by Reliance Medical Information, Inc.)
During the first 24 months of the Oregon Liver Transplantation Program, which began in October 1988, 94 patients were formally evaluated and 47 adults underwent 54 liver transplantations. Thirty-four percent of patients were veterans. The recipient operation lasted a mean of 7.4 hours (range: 4 to 16 hours). Veno-venous bypass was used routinely at first but selectively later (7 or the last 26 cases), resulting in reduced operating time. Hepatic artery reconstruction was end-to-end anastomosis in 52 cases and iliac conduit in 2. No arterial thrombosis occurred. Biliary reconstruction was choledochocholedochostomy in 83% and choledochojejunostomy in 17%. Biliary complications occurred in 28%. Operative mortality was 2%, and 1-year actual survival was 80%. Patients with hepatitis B fared worse, with four of six dying at a mean of 7.6 months. Overall, the median hospital stay was 30 days. Patients surviving more than 3 months had a mean Karnofsky score of 82%. No significant difference in outcome was noted in patients receiving prophylactic [OKT.sub.3] monoclonal antibody (used in 45%) versus conventional immunosuppressive therapy. Overall, allograft rejection occurred in 55% of patients. Retransplantation was required in seven patients, three for primary graft nonfunction, two for uncontrolled rejection during induction therapy with [OKT.sub.3], and two for graft failure secondary to recurrent hepatitis B.