ABSTRACT
OBJECTIVE: The objective of this pilot study was to investigate the potential for long-term overall survival (OS) after liver transplantation for colorectal liver metastases (CLMs). BACKGROUND: Patients with nonresectable CLMs have poor prognosis, and few survive beyond 5 years. CLMs are currently considered an absolute contraindication for liver transplantation, although liver transplantation for primary and some secondary liver malignancies shows excellent outcome in selected patients. Before 1995, several liver transplantations for CLMs were performed, but outcome was poor (5-year survival rate: 18%) and liver transplantation for CLMs was abandoned. Since then, the survival rate after liver transplantation in general has improved by almost 30%. On the basis of this, a 5-year survival rate of about 50% after liver transplantation for CLMs could be anticipated. METHODS: In a prospective pilot study, liver transplantation for nonresectable CLMs was performed (n = 21). Main inclusion criteria were liver-only CLMs, excised primary tumors, and at least 6 weeks of chemotherapy. RESULTS: Kaplan-Meier estimates of the OS rate at 1, 3, and 5 years were 95%, 68%, and 60%, respectively. Metastatic recurrence of disease was common (mainly pulmonary). However, a significant proportion of the recurrences were accessible for surgery, and at follow-up (after median of 27 months; range, 8-60), 33% had no evidence of disease. Hepatic tumor load before liver transplantation, time from primary surgery to liver transplantation, and progressive disease on chemotherapy were identified as significant prognostic factors. CONCLUSIONS: OS exceeds by far reported outcome for chemotherapy, which is the only treatment option available for this patient group. Furthermore, OS is comparable with liver resection for resectable CLMs and survival after repeat liver transplantation for nonmalignant diseases. Selection strategies based on prognostic factors may further improve the outcome (ClinicalTrials.gov: NCT01311453).
Subject(s)
Colorectal Neoplasms/pathology , Liver Neoplasms/secondary , Liver Neoplasms/surgery , Liver Transplantation , Aged , Antineoplastic Agents/therapeutic use , Chemotherapy, Adjuvant , Colorectal Neoplasms/mortality , Female , Follow-Up Studies , Humans , Liver Neoplasms/drug therapy , Liver Neoplasms/mortality , Lung Neoplasms/secondary , Male , Middle Aged , Neoadjuvant Therapy , Neoplasm Recurrence, Local , Pilot Projects , Prospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
BACKGROUND: In Norway, liver transplantation has been the treatment of choice for irreversible acute and chronic liver failure for 25 years. The aim of this article is to present a summary of the results obtained. MATERIAL AND METHODS: All liver transplants performed in Norway in the period 25.02.84-31.12.08 have been reviewed retrospectively with respect to patient and donor epidemiology, survival and recurrence. RESULTS: 651 transplants have been performed in this period. The annual number of transplants increased gradually up to the year 2000 (31), and more steeply afterwards - to 79 in 2008. Also the number of organ donations has increased and reached 98 (20 pr. million inh.) in 2008. 5-year patient survival was 53 % in the period 1984-1994. In the period 2001-2008, 1-year survival was 90 % and 5-year survival was 83 %. INTERPRETATION: The gradual improvement of results should be interpreted in light of improvements within transplant surgery, medicine and anaesthesiology and the increased local experience due to the increasing number of transplants performed. The transplant centre at Rikshospitalet has developed into being among the largest of its kind within the Nordic Countries and the results compare well with the best international data.
Subject(s)
Liver Transplantation , Adolescent , Adult , Child , Child, Preschool , History, 20th Century , History, 21st Century , Humans , Infant , Liver Failure/diagnosis , Liver Failure/surgery , Liver Transplantation/history , Liver Transplantation/mortality , Liver Transplantation/statistics & numerical data , Middle Aged , Norway/epidemiology , Registries , Retrospective Studies , Survival Rate , Tissue Donors , Waiting Lists , Young AdultABSTRACT
BACKGROUND: Organ shortage has resulted in an increased use of expanded criteria donors for transplantation, in particular kidneys from older donors. There is limited data on the impact of donor age more than 75 years on kidney transplant outcome. METHODS: A retrospective single-center analysis on deceased donors more than 75 years and kidney transplant outcome in an old for old setting was performed. Histologic findings (global kidney score) in graft biopsies and deceased-donor scores were evaluated to observe if this information could be helpful in predicting outcome. RESULTS: Evaluation of data from 54 single kidney transplantations from 29 donors more than 75 years (median 77.5, range 75.2-86.1) were assessed. Ninety-three percent of the donors died of intracranial bleeding, and 69% had a history of hypertension or cardiovascular event(s). Median recipient age was 70.1 (range 50.6-82.4). Fifty-two grafts (96%) had posttransplant function. Death censored graft survival at 1, 3, and 5 years were 87%, 83%, and 83%, respectively. Patient survival was 81%, 75%, and 59% at the same time points. At follow-up at median 23 months (range 6-144 months), thirty-five recipients were alive with a median serum creatinine of 163 micromol/ L (range 103-348). Global kidney score and deceased donor score did not predict graft outcome. CONCLUSION: Kidney transplants from deceased donors more than 75 years perform acceptable as single transplants and should be considered for use in older recipients.
