LIVER-TRANSPLANTATION - INITIAL EXPERIENCE IN THE VETERANS-ADMINISTRATION

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). The posttransplant survival rate has increased steadily to a high of 81% in 1988 (overall during the study period it was 67%). Based on these data, we conclude that; (1) earlier referral of veterans for OLTx is necessary,.(2) the presence of either a concurrent additional medical problem or metastatic cancer are common causes for denial of OLTx candidacy in veterans, and (3) transplant results obtained in the Veterans Administration are not as good as those obtained in the private sector. © 1990 Plenum Publishing Corporation.