Indications for liver transplantation in the cyclosporine era

R. D. Gordon, Byers Wendell Shaw Jr, S. Iwatsuki, C. O. Esquivel, T. E. Starzl

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

One hundred seventy orthotopic liver transplants were performed under conventional immunosuppression with azathioprine and steroids with 1- and 5-year survivals of 32.9% and 20.0%, respectively. Since the introduction of cyclosporine-prednisone therapy in March 1980, 313 primary orthotopic liver transplants have been performed. Actuarial survivals at 1 and 5 years have improved to 69.7% and 62.8%, respectively. Biliary atresia is now the most common indication for liver replacement. In adults, primary biliary cirrhosis and sclerosing cholangitis have become more common indications for transplantation, and alcoholic cirrhosis and primary liver malignancy as indications have declined. Early enthusiasm for liver transplantation in patients with hepatic cancer has been tempered by the finding that recurrence is both common and rapid. An increasing number of patients with inborn errors of metabolism originating in the liver are receiving transplants, including patients with Wilson's disease, tyrosinemia, alpha-1-antitrypsin deficiency, glycogen storage disease, familial hypercholesterolemia, and hemochromatosis. Survival in this group of patients has been excellent (74.4% at 1 and 5 years). A hemophiliac who received a transplant for postnecrotic cirrhosis has survived and may have been cured of his hemophilia. About 20% of patients require retransplantation for rejection, technical failure, or primary graft failure. Only 4 of the patients receiving retransplants under conventional immunosuppression survived beyond 6 months, and all died within 14 months of retransplantation. Sixty-eight patients have received retransplants under cyclosporine-prednisone. Thirty-one patients are surviving, all for at least 1 year. Six of the 12 patients requiring a third transplant are alive 2 to 3 years after the primary operation. An aggressive approach to retransplantation in the patient with a failed graft is justified.

Original languageEnglish (US)
Pages (from-to)541-556
Number of pages16
JournalSurgical Clinics of North America
Volume66
Issue number3
DOIs
StatePublished - Jan 1 1986

Fingerprint

Liver Transplantation
Cyclosporine
Transplants
Liver
Prednisone
Immunosuppression
Survival
Tyrosinemias
alpha 1-Antitrypsin Deficiency
Glycogen Storage Disease
Biliary Atresia
Inborn Errors Metabolism
Alcoholic Liver Cirrhosis
Sclerosing Cholangitis
Hepatolenticular Degeneration
Hyperlipoproteinemia Type II
Hemochromatosis
Biliary Liver Cirrhosis
Azathioprine
Hemophilia A

ASJC Scopus subject areas

  • Surgery

Cite this

Gordon, R. D., Shaw Jr, B. W., Iwatsuki, S., Esquivel, C. O., & Starzl, T. E. (1986). Indications for liver transplantation in the cyclosporine era. Surgical Clinics of North America, 66(3), 541-556. https://doi.org/10.1016/S0039-6109(16)43939-3

Indications for liver transplantation in the cyclosporine era. / Gordon, R. D.; Shaw Jr, Byers Wendell; Iwatsuki, S.; Esquivel, C. O.; Starzl, T. E.

In: Surgical Clinics of North America, Vol. 66, No. 3, 01.01.1986, p. 541-556.

Research output: Contribution to journalArticle

Gordon, RD, Shaw Jr, BW, Iwatsuki, S, Esquivel, CO & Starzl, TE 1986, 'Indications for liver transplantation in the cyclosporine era', Surgical Clinics of North America, vol. 66, no. 3, pp. 541-556. https://doi.org/10.1016/S0039-6109(16)43939-3
Gordon, R. D. ; Shaw Jr, Byers Wendell ; Iwatsuki, S. ; Esquivel, C. O. ; Starzl, T. E. / Indications for liver transplantation in the cyclosporine era. In: Surgical Clinics of North America. 1986 ; Vol. 66, No. 3. pp. 541-556.
@article{8afd7b7cf6604cdd9ebd202f47ac280d,
title = "Indications for liver transplantation in the cyclosporine era",
abstract = "One hundred seventy orthotopic liver transplants were performed under conventional immunosuppression with azathioprine and steroids with 1- and 5-year survivals of 32.9{\%} and 20.0{\%}, respectively. Since the introduction of cyclosporine-prednisone therapy in March 1980, 313 primary orthotopic liver transplants have been performed. Actuarial survivals at 1 and 5 years have improved to 69.7{\%} and 62.8{\%}, respectively. Biliary atresia is now the most common indication for liver replacement. In adults, primary biliary cirrhosis and sclerosing cholangitis have become more common indications for transplantation, and alcoholic cirrhosis and primary liver malignancy as indications have declined. Early enthusiasm for liver transplantation in patients with hepatic cancer has been tempered by the finding that recurrence is both common and rapid. An increasing number of patients with inborn errors of metabolism originating in the liver are receiving transplants, including patients with Wilson's disease, tyrosinemia, alpha-1-antitrypsin deficiency, glycogen storage disease, familial hypercholesterolemia, and hemochromatosis. Survival in this group of patients has been excellent (74.4{\%} at 1 and 5 years). A hemophiliac who received a transplant for postnecrotic cirrhosis has survived and may have been cured of his hemophilia. About 20{\%} of patients require retransplantation for rejection, technical failure, or primary graft failure. Only 4 of the patients receiving retransplants under conventional immunosuppression survived beyond 6 months, and all died within 14 months of retransplantation. Sixty-eight patients have received retransplants under cyclosporine-prednisone. Thirty-one patients are surviving, all for at least 1 year. Six of the 12 patients requiring a third transplant are alive 2 to 3 years after the primary operation. An aggressive approach to retransplantation in the patient with a failed graft is justified.",
author = "Gordon, {R. D.} and {Shaw Jr}, {Byers Wendell} and S. Iwatsuki and Esquivel, {C. O.} and Starzl, {T. E.}",
year = "1986",
month = "1",
day = "1",
doi = "10.1016/S0039-6109(16)43939-3",
language = "English (US)",
volume = "66",
pages = "541--556",
journal = "Surgical Clinics of North America",
issn = "0039-6109",
publisher = "W.B. Saunders Ltd",
number = "3",

}

TY - JOUR

T1 - Indications for liver transplantation in the cyclosporine era

AU - Gordon, R. D.

AU - Shaw Jr, Byers Wendell

AU - Iwatsuki, S.

AU - Esquivel, C. O.

AU - Starzl, T. E.

PY - 1986/1/1

Y1 - 1986/1/1

N2 - One hundred seventy orthotopic liver transplants were performed under conventional immunosuppression with azathioprine and steroids with 1- and 5-year survivals of 32.9% and 20.0%, respectively. Since the introduction of cyclosporine-prednisone therapy in March 1980, 313 primary orthotopic liver transplants have been performed. Actuarial survivals at 1 and 5 years have improved to 69.7% and 62.8%, respectively. Biliary atresia is now the most common indication for liver replacement. In adults, primary biliary cirrhosis and sclerosing cholangitis have become more common indications for transplantation, and alcoholic cirrhosis and primary liver malignancy as indications have declined. Early enthusiasm for liver transplantation in patients with hepatic cancer has been tempered by the finding that recurrence is both common and rapid. An increasing number of patients with inborn errors of metabolism originating in the liver are receiving transplants, including patients with Wilson's disease, tyrosinemia, alpha-1-antitrypsin deficiency, glycogen storage disease, familial hypercholesterolemia, and hemochromatosis. Survival in this group of patients has been excellent (74.4% at 1 and 5 years). A hemophiliac who received a transplant for postnecrotic cirrhosis has survived and may have been cured of his hemophilia. About 20% of patients require retransplantation for rejection, technical failure, or primary graft failure. Only 4 of the patients receiving retransplants under conventional immunosuppression survived beyond 6 months, and all died within 14 months of retransplantation. Sixty-eight patients have received retransplants under cyclosporine-prednisone. Thirty-one patients are surviving, all for at least 1 year. Six of the 12 patients requiring a third transplant are alive 2 to 3 years after the primary operation. An aggressive approach to retransplantation in the patient with a failed graft is justified.

AB - One hundred seventy orthotopic liver transplants were performed under conventional immunosuppression with azathioprine and steroids with 1- and 5-year survivals of 32.9% and 20.0%, respectively. Since the introduction of cyclosporine-prednisone therapy in March 1980, 313 primary orthotopic liver transplants have been performed. Actuarial survivals at 1 and 5 years have improved to 69.7% and 62.8%, respectively. Biliary atresia is now the most common indication for liver replacement. In adults, primary biliary cirrhosis and sclerosing cholangitis have become more common indications for transplantation, and alcoholic cirrhosis and primary liver malignancy as indications have declined. Early enthusiasm for liver transplantation in patients with hepatic cancer has been tempered by the finding that recurrence is both common and rapid. An increasing number of patients with inborn errors of metabolism originating in the liver are receiving transplants, including patients with Wilson's disease, tyrosinemia, alpha-1-antitrypsin deficiency, glycogen storage disease, familial hypercholesterolemia, and hemochromatosis. Survival in this group of patients has been excellent (74.4% at 1 and 5 years). A hemophiliac who received a transplant for postnecrotic cirrhosis has survived and may have been cured of his hemophilia. About 20% of patients require retransplantation for rejection, technical failure, or primary graft failure. Only 4 of the patients receiving retransplants under conventional immunosuppression survived beyond 6 months, and all died within 14 months of retransplantation. Sixty-eight patients have received retransplants under cyclosporine-prednisone. Thirty-one patients are surviving, all for at least 1 year. Six of the 12 patients requiring a third transplant are alive 2 to 3 years after the primary operation. An aggressive approach to retransplantation in the patient with a failed graft is justified.

UR - http://www.scopus.com/inward/record.url?scp=0022499656&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0022499656&partnerID=8YFLogxK

U2 - 10.1016/S0039-6109(16)43939-3

DO - 10.1016/S0039-6109(16)43939-3

M3 - Article

VL - 66

SP - 541

EP - 556

JO - Surgical Clinics of North America

JF - Surgical Clinics of North America

SN - 0039-6109

IS - 3

ER -