Table 1.
| Consecutive Recent Orthotopic Liver Transplantations (OT) | |||||||
|---|---|---|---|---|---|---|---|
| OT NO. | Diagnosis | Donor/Recipient Age, yr | Ischemia Time, hr, min | Survival, Days | Last Bilirubin, Level, mg/dL | Cause of Death, Clinical and Autopsy | Graft Histopathology |
| 141 | Chronic aggressive hepatitis, hepatitis B surface antigen positive (HBsAg +) | 17/31 | 2,46 | 355 | 28 | Liver failure from chronic rejection and recurrent hepatitis | End-stage chronic rejection; Biopsy (bx,) results at 147 and 179 days had shown progressing rejection; no evidence of recurrent hepatitis B infection |
| 142 | Alpha1-antitrypsin deficiency (with hepatoblastoma) | 3½/5 | 3,42 | 612 | 0.8 | Alive | Bx results at 166 days and 1 yr, 57 days showed continuing low-grade rejection |
| 143 | Sclerosing cholangitis | 17/31 | 1,45 | 386 | 16 | Intraabdominal infection; liver failure from chronic rejection; and (?) cholangitis | Diffuse fatty change and some centrilobular necrosis; no evidence of rejection or sclerosing cholangitis |
| 144 | Alcoholic cirrhosis (previous shunt) | 19/39 | 6,15 | 563 | 0.8 | Alive | No bx |
| 145 | Chronic aggressive hepatitis (previous shunt) | 15/22 | 7,18 | 20 | 16 | Acute liver failure from ischemic graft injury; candidiasis | No ischemic injury in bx results at 14 days, only evidence of biliary obstruction; same at autopsy |
| 146 | Primary biliary cirrhosis | 21/49 | 1,23 | 502 | 0.8 | Alive | Bx results at 30 and 111 days showed cellular rejection; no evidence of hepatitis despite being HBsAg + |
| 147 | Biliary atresia | 2½/5½ | 7,26 | 42 | 3.7 | Peritonitis from enteric fistula; candidiasis | Diffuse fatty change; multiple small foci of Candida infection |
| 148 | Chronic aggressive hepatitis | (a)13/29 (b)18/29 |
1,17 1,29 |
16 | 34 | Acute liver failure from (?) ischemic graft injury, 1st graft; Gram-negative septicemia, 2nd graft | (a) Acute cellular rejection; (b)Fatty change and some cholestasis in centrilobular hepatocytes ____ |
| 149 | Sclerosing cholangitis | 18/38 | 1,34 | 80 | 10.6 | Peritonitis and persistent duodenal fistula; pneumonitis | Centrilobular fatty Change; arteriolar narrowing from past rejection ____ |
| 150 | Biliary cirrhosis (secondary to trauma) | 7/15 | 2,2 | 472 | 0.8 | Alive | Bx result at 33 days showed acute cellular rejection |
| 151 | Biliary atresia (previous Kasai procedure) | 2/5 | 8,51 | 72 | 3.3 | Chicken pox; fresh portal thrombosis | Herpes group viruses seen by electron microscopy in necrotic tissue and in some of adjacent cells |
| 152 | Biliary cirrhosis (secondary to choledochocyst) | 1½/29 | 2,5 | 19 | 8.3 | Peritonitis from enteric fistulas; questionable candidiasis; no autopsy | No bx or autopsy |
| 153 | Chronic aggressive hepatitis | 16/28 | 2,30 | 21 | 1.8 | Acute hemorrhage from esophageal varices* | Some atrophy of hepatocytes because of lack of portal blood; no evidence of rejection |
| 154 | Alpha1-antitrypsin deficiency | 4/6 | 8,23 | 54 | 11 | Liver failure with intrahepatic arterial thrombosis; regional liver infarctions and Gram-negative septicemia | Intrahepatic arterial thromboses and infarcts in bx results at 29 days and at autopsy; no evidence of rejection in surviving liver; (?) primary thrombosis due to endothelial damage caused by eight hr ischemia . |
| 155 | Alpha1-antitrypsin deficiency | 8/11 | 1,24 | 395 | 0.5 | Alive | Bx result at six mo showed acute cellular rejection |
| 156 | Chronic aggressive hepatitis | (a) 8/24 (b) 24/34 |
7,20 5,23 |
194 | 6 | Acute liver failure from Ischemic injury, 1st graft; arterial thrombosis, 2nd graft, neurologic invalidism | (a) Cholangitis, centrilobular cholestasis and marked centrilobular and midzonal fatty change; did not look like Simple ischemic damage (b) Bx results at 69 and 124 days showed acute and chronic rejection, respectively, with arterial involvement; at autopsy at 179 days there were multiple large areas of old and recent ischemic necrosis and atrophy of hepatocytes caused by arterial lesions of chronic rejection |
| 157 | Chronic aggressive hepatitis | 19/21 | 2,10 | 120 | 35 | Liver failure from portal thrombosis and (?) chronic rejection | Bx results at 14, 62 and 109 days showed progression from acute cellular rejection to chronic rejection with narrowing and obliteration of intrahepatic artery branches and portal vein tributaries; at autopsy large areas of hemorrhagic necrosis from recent main portal vein thrombosis predominated |
| 158 | Congenital hepatic fibrosis | 2/2 | 1,45 | 21 | 15.4 | Acute rejection | Acute cellular rejection with necrosis of centrilobular and midzonal hepatocytes |
| 159 | Alpha1-antitrypsin deficiency | 3/9 | 7,39 | 56 | 0.8 | Pulmonary emboli | Little fat in hepatocytes; mild mononuclear cell infiltration of portal tract |
| 160 | Protoporphyria | 9/21 | 8 | 26 | 10.8 | Cardiac insufficiency; candidiasis | Fatty change and some cholestasis |
| 161 | Biliary atresia (previous Kasai procedure) | 1/2 | 7,12 | 28 | 1.1† | (?) Adenovirus hepatitis; Gram-negative septicemia | Bx results at 16 days showed acute cellular rejection; no autopsy tissue available |
| 162 | Biliary atresia (previous Kasai procedure) | 1/2½ | 6,26 | 5 | 3.4 | Respiratory insufficiency from oversized graft | Focal areas of centrilobular and midzonal hemorrhagic necrosis; fatty change, cell cholestasis and moderately dense mononuclear cell infiltration of portal tracts |
| 163 | Biliary atresia | 1½/3 | 1,23 | 30 | 2.6† | (?) Adenovirus hepatitis | Multiple focal areas of necrosis; some of these contain large candida colonies; nuclear inclusions in the hepatocytes bordering the necrotic foci; by electron microscopy these are found to consist of adenovirus particles |
*
At operation, portal cavernous transformation found. Graft portal vein anastomosed to vena caval which subsequently clotted.
†
Last SGOT values more than 2,000 IU/L.