The first 1,000 liver transplantations in IKEM
Pavel Trunečka1, Jiří Froněk Orcid.org 2, Libor Janoušek Orcid.org 3, Martin Oliverius4, Miloš Kučera Orcid.org 3, Eva Kieslichová Orcid.org , Milan Ročeň Orcid.org , Julius Špičák Orcid.org 5, Jan Šperl Orcid.org 5, Halima Gottfriedová Orcid.org 5, Soňa Fraňková Orcid.org 5, Pavel Drastich Orcid.org 5, Irena Hejlová Orcid.org 5, Eva Pokorná Orcid.org , Eva Honsová Orcid.org 6, Jan H Peregrin Orcid.org , Věra Lánská Orcid.org 7, David Hačkajlo Orcid.org , Lucie Janečková Orcid.org 8, Aleš Herman Orcid.org 9
1 Transplantcentrum, IKEM, Praha
2 Klinika transplantační chirurgie, Transplantcentrum, IKEM, Praha
3 Klinika transplantační chirurgie, IKEM, Praha
4 Klinika transplantační chirurgie IKEM Praha
5 Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha
6 Pracoviště klinické a transplantační patologie, Transplacentrum, IKEM, Praha
7 Lékařská statistika, IKEM, Praha
8 Klinika anesteziologie, resuscitace a intenzivní péče, IKEM, Praha
9 Oddělení lékařské statistiky, IKEM, Praha
One thousand orthotopic liver transplantations (LTx) were performed in the Transplant Centre of the Institute of Clinical and Experimental Medicine in Prague in 950 transplant recipients, 559 men and 391 females, aged 0.4-74 years during the period between April 2,1995 and August 13, 2013. At the beginning of the programme, the average age of the recipients was 41, and 48.8 in 2012 (including child recipients). At the beginning, the average MELD/PELD score was 18.5, and this decreased to 16.3 in 2012. During the same period the mean waiting time of the listed patients increased from 42.3 to 164.9 days. Out of the total, 28 LTx were performed simultaneously with a kidney transplantation, and two with a pancreatic islets transplantation. The most frequent chronic liver disease in the patients listed for the first LTx was alcoholic liver cirrhosis in 25.4% recipients, hepatitis C cirrhosis in 13.5%, and primary sclerosing cholangitis in 11% of patients. An acute form of Wilson's disease in 37% and a fulminant course of hepatitis B in 18.5% of patients were the most prevalent indications among the urgently listed patients. Initial immunosuppression was provided based on various combinations; the main medicine being calcineurine inhibitors (99.5%) of which Cyclosporin A was used in 266 and Tacrolimus in 729 recipients. One-year survival of recipients (Kaplan-Meier method) was 89.8%, five-year 83.1%, 10-year 75.5%, and 15-year 65.2%, and the graft survival was 86.6%, 79.4%, 71.0%, and 60.2 % respectively. The best patient and graft survival rate was achieved in patients transplanted for biliary cirrhosis and was significantly betterthan in any other indication group (p< 0.027).The main cause of mortality among transplant recipients during the first post-transplant year (89 cases) was sepsis (20 patients) and de novo tumours in the following years (104 cases). Liver transplantation is a very effective life-saving method with a remarkable long-term survival probability which returns many liver transplant recipients to full activity in their physical and social lives.
Keywordsimmunosuppression, survival, liver transplantation
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