The first one thousand liver transplants in Turin: a single-center experience in Italy

Abstract

Summary The first Italian liver transplant center to reach the goal of 1000 procedures was Turin. The paper reports this single‐center experience, highlighting the main changes that have occurred over time. From 1990 to 2002, 1000 consecutive liver transplants were performed in 910 patients, mainly cirrhotics. Surgical technique was based on the preservation of the retrohepatic vena cava of the recipient. The veno‐venous bypass was used in 30 cases only and abandoned since 1997. Operating time, warm ischemia time and length of hospital stay significantly decreased over the years, while operating room extubation became routine. Immunosuppression pivoted on cyclosporine A. Management of retransplantations, marginal grafts, and of HCV‐positive, HBV‐positive and hepatocellular carcinoma recipients were optimized. Median follow‐up of the patients was 41 months. Overall survival rates at 1, 5 and 10 years were 87%, 78% and 72% respectively. Survival rates obtained in the second half of the cases (1999–2002 period) were significantly better than those obtained in the first half (1990–1998 period) (90% vs. 83% at 1 year and 81% vs. 76% at 5 years respectively). Increasing experience in liver transplant surgery and postoperative care allowed standardization of the procedure and expansion of the activity, with parallel improvement of the results.

Twenty-Year Longitudinal Follow-Up After Orthotopic Liver Transplantation: A Single-Center Experience of 313 Consecutive Cases

“…Since the first liver transplantation (LT) in 1963 (1), shortterm survival has improved rapidly (2,3). However, longterm attrition rates have not changed similar (4).…”

Early Liver Transplantation for Neonatal-Onset Methylmalonic Acidemia

“…25 Additionally, children with these rare conditions are looked after by tertiary specialists in metabolic units, often with no direct links to the transplant centers, so that the patients are proposed for liver transplant when the margins for recuperation are limited. 22 Relying on an experienced liver transplant center, 26 we treated by early liver transplant 2 patients with severe MCM deficiency. This "partial enzyme replacement" approach was chosen after careful assessment of an acceptable risk for the patients, balancing the natural course under conventional treatment, the transplant risks, and the expected clinical benefits from the procedure.…”

COBAS AmpliPrep-COBAS TaqMan Hepatitis B Virus (HBV) Test: a Novel Automated Real-Time PCR Assay for Quantification of HBV DNA in Plasma

“…It is estimated that nearly 2 billion people are infected worldwide by HBV and that more than 350 million have persistent and chronic infection (38). HBV carriers have a high risk of developing long-term sequelae of hepatitis B, including cirrhosis and hepatocellular carcinoma that, in countries such as Italy with a moderate prevalence of HBV infection, account for nearly 25% of the indications for liver transplantation in reference centers (29). Recent advances in antiviral therapy, based on the development of new and more powerful nucleos(t)ide analogues, have dramatically improved chronic hepatitis B management, including the prevention of allograft reinfection in those patients undergoing liver transplantation for HBV-related disease.…”