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The Veterans Administration entered the clinical liver transplant field in 1983 and continued its program through July 1988. During this time interval, from the 172 Veterans Administration Medical Centers in the United States, 146 contact calls were initiated to the single center authorized to do liver transplants for the Veterans Administration. One hundred one (69%) of these contact calls resulted in a patient evaluation. Of the 101 patients evaluated, 77 (76%) were accepted for liver transplantation (OLTx). Of these 77, 67 (87%) were transplanted. The reasons for denial of transplant evaluation were numerous and included metastatic cancer, active alcoholism, homosexuality, and a variety of concurrent medical problems. The reasons for denying liver transplantation after evaluation were similar and included concurrent medical problems that contraindicated transplantation (N = 14), metastatic cancer (N = 6), and liver disease of insufficient severity to justify transplantation (N = 3). The number of transplants performed annually by the Veterans Administration increased from one in 1983 to 21 in 1988. Seventeen second grafts and two third grafts were transplanted in 17 cases, resulting in a retransplant rate of 22%; 46% of the patients receiving a second graft survived. None of those receiving three grafts survived. The reasons for retransplantation included acute and/or chronic rejection (N = 6), hepatic artery thrombosis (N = 5), primary graft failure (N = 4), recurrent cancer (N = 2), fulminant hepatitis and portal venous emboli (one each). A total of 45 transplanted patients are still alive (67% of those transplanted).(ABSTRACT TRUNCATED AT 250 WORDS)

The pathologic specimens (n = 118) and hospital course pertinent to each of 62 adult liver allograft recipients were reviewed. Biopsies and retransplanted organs were obtained at the discretion of the surgical team on the basis of the postoperative clinical course (less than 1 day to greater than 12 years after transplantation), and final interpretation of the pathologic material was based on a correlation of all available data. Most of the specimens (n = 85) were obtained within the first 2 months, and diagnoses in this time period included rejection, biliary obstruction/cholangitis, vascular injury, herpesvirus and cytomegalovirus hepatitis, graft necrosis, and functional cholestasis. Thereafter, rejection and recurrent or primary viral hepatitis were the major causes of graft dysfunction. Histologically, hepatic rejection is manifested by a cellular mediated injury of hepatocytes and bile ductules and a spectrum of vascular lesions in medium-sized hilar arteries. Morphologic changes of biliary duct obstruction and viral liver disease were at times difficult to differentiate from rejection. Two pretransplant disorders, type B viral hepatitis and the Budd-Chiari syndrome, recurred in grafted organs. Although interpretation of pathologic material may be difficult at times, it frequently is helpful in planning an approach to management of liver allograft recipients.