For liver transplants, the most common diagnoses are autoimmune hepatitis and
hepatitis C. Other diagnoses for patients referred to the liver transplant unit
are acute liver failure from viral causes (viral infections, toxic damage,
medication induced, etc.), chronic cirrhosis leading to end stage liver disease
from viral hepatitis B and C, primary biliary cirrhosis, primary sclerosing
cholangitis, metabolic diseases, liver tumors and, in children, biliary atresia
and other inborn errors of metabolism.
Patients referred for transplant are evaluated typically in about two or
three days. These tests are designed to assess the patient's need for
transplantation and the urgency. They include blood tests, imaging tests,
evaluation of the heart and lung function along with psycho/social evaluation
followed by an extensive interview. About 80 percent of physician-referred
patients have been accepted as candidates for liver transplants, including a
number of patients who were turned down elsewhere due to the complexity of their
disease, but have been transplanted successfully at our center.
Once the evaluation phase is completed, the patient is immediately presented
at the Liver Transplant Recipient review committee, which includes specialists
in cardiology, nephrology, ethics, neurology, addictionology, transplant
coordination, social work, etc. Once a patient has been accepted as a candidate
for transplantation, his or her waiting time can vary widely depending on blood
group, the urgency of the medical condition and the unpredictability of the gift
of a suitable donor.
The liver transplant operation itself takes an average of eight to 10 hours,
but longer or shorter times are not unusual. Liver transplants as quick as five
to six hours are not infrequent with current improvement in surgical technique
and avoidance of veno-venous bypass. The median length of stay in the hospital
for a liver transplant is 15 days, with 25 percent of cases being discharged
home as early as six to eight days. This is possible mainly because of a
dedicated, transplant intensive care unit with a full-time transplant/critical
care specialist who manages the patients 24 hours a day, along with a committed
team of transplant trained specialists in every transplant-related field of
medicine.
An analysis of the 1997 report published by the U.S. Department of Health and
Human Services shows that among the 32 centers (of 99 total centers) that
exceeded 60 transplants in the report's most recent two-year interval, NZTI
ranked fourth in actual one-year survival (90 percent) and sixth in
disease-severity-adjusted one-year survival. NZTI's current one-, two-, three-
and five-year survivals are 89 percent, 86 percent, 83 percent and 75
percent.