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The authors report their experience on 313 liver transplantations performed in 255 patients. In 51.7% the indication to liver transplant was the cirrhosis, post alcoholic in 39.5% and post-hepatitis in 24.1%. The global mortality was 34.9% (89/255) with an actuarial survival of 53% at 74 months. We registered 10 cases (3.2%) of arterial thrombosis and 5 cases (1.6%) complications of portal anastomosis.

Indications for liver transplant in acute fulminating hepatitis (AFH) are predominantly affected by the high mortality of this spontaneous evolution (80-100%). At present patients with AFH have priority for transplant since they form part of the 0 emergency group according to the National Transplant Organisation. During the period between 1986 and the end of February 1992, a total of 254 liver transplants were performed in 202 patients (52 retransplants). In 26 patients (12.8%) (16 females and 10 males) the indication was fulminating acute hepatitis. Etiology was unknown in 20 patients, secondary to hepatitis B in 4 and to hepatitis A in 1, and was caused by isonazide ingestion in 1 case. The age limits were 3-60 years (X = 31.5 years). An isogroup graft was performed in 16 patients (61.5%), compatible in 3 (11.6%) and incompatible in 7 (26.9%). Due to anthropometric differences, a partial graft was used in 7 patients (26.9%); in 2 of the latter the graft was taken from the same donor ("split-liver"). Placement was always orthotopic with resection of the retrohepatic vena cava in 25 patients and its preservation in 1 (left lobe of split-liver). Peroperative (30 days) mortality was 23% (6/26); 2 due to cerebral death, 2 due to sepsis, 1 due to multisystemic insufficiency (MSI) and 1 due to acute pancreatitis. Four patients (15.3%) died some time after transplant; 1 after 5 months due to broncho-pulmonary complications, 1 after 7 months due to subacute hepatitis, 1 after 3 months due to respiratory failure and the last after 5 months due to anoxic encephalopathy and lung infection. Ten patients (39.4%) were re-transplanted; 4 following chronic rejection, 4 due to primary graft no function, 1 due to arterial thrombosis and 1 due to recurrent hepatitis (with cirrhosis). Two of the latter patients died intraoperatively due to coagulopathy and hemorrhage, and 3 following surgery (1 due to sepsis, 1 due to respiratory complications and 1 due to respiratory insufficiency). Two patients underwent a second re-transplant (1 due to chronic rejection and 1 due to recurrent hepatitis) and of these 1 died peroperatively due to sepsis and MSF. Overall mortality was therefore 61.5% (16/26) and the actuarial survival rate of 17 patients (10 living + 7 postoperative deaths) was 68% at 12 months and 52.9% at 36 months. Even if peroperative mortality is relatively high, liver transplant is currently the elective treatment for fulminating acute hepatitis.

One hundred and thirty-eight transplants were performed between April 1986 and June 1990 in 116 patients of whom 9 (7.75%) were affected by liver cirrhosis complicated by portal vein thrombosis. Occlusion of the vascular lumen was total in 3 cases, semitotal in 1 case and the percentage of obstruction ranged between 25% and 75% in the remaining patients. Venous dissection and thrombectomy were performed in 6 cases and simple thrombectomy in 3 cases in order to obtain a satisfactory blood flow. Anastomosis was effected using the spleno-mesenteric confluence in 2 cases and the portal vein itself in other patients. Recurrent thrombosis occurred in the first 4 patients in the series, but it was only fatal in 2 cases. The paper analyses the data obtained from the study and in conclusion confirms the use of transplant in cirrhotic patients with portal vein thrombosis.