Liver transplantation - initial experience at Colombo North Liver Transplantation Service

Abstract

INTRODUCTION: Liver transplantation (LT) is the treatment of choice for end stage liver diseases. LT is still in its infancy in Sri Lanka. AIMS: To describe the initial experience of the Colombo North Liver Transplantation Service (CNLTS) METHODS: The study population included all patients referred for LT to CNLTS. All cases were evaluated for the indication and medical, social and psychological suitability for LT. Decision to list patients for LT was reached by a multidisciplinary team consisting of surgeons, physicians and anaesthetists. All data were collected prospectively. RESULTS: 52 patients were referred for LT over a period of 7 months. 48/52[92.3%) were males. The median age at referral was 52(range 13-66) years. The median Child-Turcotte-Pugh(CTP) score at referral was 9/15(range 5-13/15). Median Model for End Stage Liver Disease (MELD) score at referral was 17(range 9-26). 3/52(5.8%) had hepatocellular carcinoma and 9/52(17.3%) had a low MELD score (<14) but with life threatening complications of cirrhosis as indication. 4/9(44.4%) of those being upper gastrointestinal bleeds from varices. 28/52(53.8%) of the referrals had cryptogenic cirrhosis (CC), 18/52(34.6%) had alcoholic cirrhosis, 2/52(3.8%) each had metabolic, congenital and other causes for cirrhosis. 7/52(13.5%) transplants were performed [3 Live Donor LTs(LDLT) and 4 Deceased Donor LTs(DDLT)]. 5/7(71.4%)[2 - LDLT, 3 -DDLT] had a successful LT outcome. 11/45(24.4%) patients died while on the LT waiting list. CONCLUSIONS: High MELD CC was the commonest reason for referral for LT in our group. There was a high waiting list mortality highlighting the need for an efficient DDLT service.