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The Australian National Liver Transplantation Unit the first two years
CONFEDERATION OF AUSTRALIAN CRITICAL CARE NURSES JOURNAL
THE AUSTRALIAN NATIONAL LIVER TRANSPLANTATION UNIT THE FIRST 1WO YEARS Jillian Church R.N. C.N.S. E7 I.C.U Royal Prince Alfred Hospital Camperdown, N.S.W:
Sandra Norman R.N. C.N.S. E6 I.C.U Royal Prince Alfred Hospital Camperdown, N.S.W:
IN1RODUCnON
TABLEt The first liver transplant at the Australian National Liver Transplantation Unit (ANLTU), based at Royal Prince Alfred Hospital - Children's Hospital Camperdown - Sydney University, was performed in January 1986.
PATIIOLOGY OF TRANSPLANTED PATIENTS (JANUARY 1986 - SEPTEMBER 1988) NUMBER
DIAGNOSIS
The liver transplant team consists of some fifty (50) personnel, including anaesthetists, haematologists, physicians, surgeons, and theatre staff. However, above this figure there are many experienced nursing staff whose clinical expertise is necessary for the satisfactory care of these patients, during the immediate pre and post operative and recuperation periods.
Primary biliary cirrhosis 7 2 Secondary biliary cirrhosis Cryptogenic cirrhosis 1 Alcoholic cirrhosis 1 Primary sclerosing cholangitis 6 4 Biliary atresia 4 Chronic active hepatitis Alpha 1 anti trypsin deficiency 3 Wilson's disease 3 Tumour - hepatoma 3 Tyrosinaemia 1 Nodular regenerative hyperplasia 1 Hepatic haemangiosarcoma 1
This paper will discuss the general patient statistics of the first two (2) years of liver transplantation at the ANLTU, including the reasons for transplant, admission and exclusion criteria for the programme, and the eventual outcome of those patients transplanted.
TABLE 2
REVIEW
CRffERIA FOR ADMISSION TO 1HE PROGRAMME (1)
From January 1986 to September 1988, forty one (41) liver transplants were performed on thirty seven (37) patients, twenty eight (28) adults and nine (9) children. The pathological conditions seen in these patients are shown in Table 1.
1. Chronic, progressive, irreversible
liver disease. 2. The liver disease being intractable to medical/surgical intervention.
Prior to admission to the programme the patients are referred to the liver transplant team for assessment. If the patient meets the criteria (Table 2) and shows no contraindications for surgery (Table 3) the patient is accepted on to the
3. Absence of contraindictions. 4. Ability of the patient and/or parents to accept the nature, risks and outcome of liver transplant. 30
VOL.l NO.4 1988
TABLE 3
programme and is said to be "activated".
RELATIVE CONTRAINDICA110NS FOR ADMISSION TO 11IE PROORAMME (2)
Prior to admission to the programme the patient undergoes extensive biochemical, haematological, immunological, and radiological tests and has consultations with the unit psychiatrist and social worker. The co-ordinator of the transplant team introduces the patient to successful transplant recipients and accompanies them on visits to the operating theatre, intensive care and related units. The average number of patients activated for liver patients is shown in Table 4. The mean waiting time for transplant (post activation) is thirty two (32) days for adults, with a range of zero to eighty seven (0-87) days. Children have a mean waiting period of one hundred and nine (l09) days, with a range of sixteen to four hundred and forty two (16-442) days. Recently, the use of ultrasonic dissection of adult livers has revolutionised the transplantation of children and, should thus decrease the waiting period in the future.
1. Extra-hepatic malignancy. 2. Active alcoholism. 3. Extra-hepatobiliary sepsis. 4. Severe medical diseases e.g. renal/cardiac disease. 5. Multiple previous abdominal surgery.
6. Active hepatitis B (e antigen positive). 7. Aged greater than fifty five (55)
years. (N.B. A sixty six (66) year old male was successfully transplanted in 1987). 8. Pyschological instability.
TABLE 4
TABLE 5
OUTCOME OF PATIENTS ACTIVATED
CAUSE OF DEAm IN TRANSPLANT RECIPIENTS
(JANUAY 1986 - SEPTEMBER 1988) CURRENTLY WAITING
TRANSPLANTED
ADULTS CHILDREN
Air embolus Cerebal infarct Cerebral haemorrhage Viral infections Hypoxia Sepsis Secondary haemorrhage Chronic rejection Hyperacute rejection Intraoperative exsanguination
DIED WAITING
ADULTS
3
28
8
CHILDREN
3
9
3
TOTAL
6
37
11
31
1 1 2 1
1 1
2
1 3 1 1
CONFEDERATION OF AUSTRALIAN CRITICAL CARE NURSES JOURNAL
To September 1988, fourteen (14) patients have
ACKNOWLEDGEMENTS
died post-operatively of various complications and one (1) has died intra-operatively (Table 5).
The encouragement and assistance of the following Royal Prince Alfred Hospital staff of the Australian
Twenty (20) of the transplant recipients are either
National Liver Transplant Unit is gratefully
convalescing satisfactorily or leading normal lives,
acknowledged.
two (2) are currently receiving acute care for post-operative complications. Confirmation of the
G. Kyd, R.N., National Liver Transplant
quality of life post-transplantation is illustrated by
Co-ordinator
the fact that five (5) patients have returned to
R. Sloan, R.N., C.N.S. - Liver Diseases.
continue their education at either primary, secondary or tertiary level. Other recipients have returned to former occupations, taken up new
REFERENCES
employment or retired. One recipient is currently 1. KYD, G. (1987). The R.P.A.C.H./C.H.C. Liver
in the third (3rd) trimester of pregnancy. The five (5)
most recent transplant recipients are in good
Transplant Unit. R.P.A. Magazine Vol. 85, No.
health and convalescing in hospital or at home.
329, pp. 7.
2. HAWKER, F. (1988) Intensive Care Manual.
CONCLUSION
3rd Edition, (In press). The above review indicates that liver transplantation in Australia, although in its infancy, has been successful in prolonging the life of patients with end stage liver disease. The majority of recipients are leading productive, normal lives with enhanced quality of life. In the future there is need for increasing research and documentation of the recipients' morbidity to effectively monitor the success of the ANLTU programme.
32
THE AUSTRALIAN NATIONAL LIVER TRANSPLANTATION UNIT THE FIRST 1WO YEARS Jillian Church R.N. C.N.S. E7 I.C.U Royal Prince Alfred Hospital Camperdown, N.S.W:
Sandra Norman R.N. C.N.S. E6 I.C.U Royal Prince Alfred Hospital Camperdown, N.S.W:
IN1RODUCnON
TABLEt The first liver transplant at the Australian National Liver Transplantation Unit (ANLTU), based at Royal Prince Alfred Hospital - Children's Hospital Camperdown - Sydney University, was performed in January 1986.
PATIIOLOGY OF TRANSPLANTED PATIENTS (JANUARY 1986 - SEPTEMBER 1988) NUMBER
DIAGNOSIS
The liver transplant team consists of some fifty (50) personnel, including anaesthetists, haematologists, physicians, surgeons, and theatre staff. However, above this figure there are many experienced nursing staff whose clinical expertise is necessary for the satisfactory care of these patients, during the immediate pre and post operative and recuperation periods.
Primary biliary cirrhosis 7 2 Secondary biliary cirrhosis Cryptogenic cirrhosis 1 Alcoholic cirrhosis 1 Primary sclerosing cholangitis 6 4 Biliary atresia 4 Chronic active hepatitis Alpha 1 anti trypsin deficiency 3 Wilson's disease 3 Tumour - hepatoma 3 Tyrosinaemia 1 Nodular regenerative hyperplasia 1 Hepatic haemangiosarcoma 1
This paper will discuss the general patient statistics of the first two (2) years of liver transplantation at the ANLTU, including the reasons for transplant, admission and exclusion criteria for the programme, and the eventual outcome of those patients transplanted.
TABLE 2
REVIEW
CRffERIA FOR ADMISSION TO 1HE PROGRAMME (1)
From January 1986 to September 1988, forty one (41) liver transplants were performed on thirty seven (37) patients, twenty eight (28) adults and nine (9) children. The pathological conditions seen in these patients are shown in Table 1.
1. Chronic, progressive, irreversible
liver disease. 2. The liver disease being intractable to medical/surgical intervention.
Prior to admission to the programme the patients are referred to the liver transplant team for assessment. If the patient meets the criteria (Table 2) and shows no contraindications for surgery (Table 3) the patient is accepted on to the
3. Absence of contraindictions. 4. Ability of the patient and/or parents to accept the nature, risks and outcome of liver transplant. 30
VOL.l NO.4 1988
TABLE 3
programme and is said to be "activated".
RELATIVE CONTRAINDICA110NS FOR ADMISSION TO 11IE PROORAMME (2)
Prior to admission to the programme the patient undergoes extensive biochemical, haematological, immunological, and radiological tests and has consultations with the unit psychiatrist and social worker. The co-ordinator of the transplant team introduces the patient to successful transplant recipients and accompanies them on visits to the operating theatre, intensive care and related units. The average number of patients activated for liver patients is shown in Table 4. The mean waiting time for transplant (post activation) is thirty two (32) days for adults, with a range of zero to eighty seven (0-87) days. Children have a mean waiting period of one hundred and nine (l09) days, with a range of sixteen to four hundred and forty two (16-442) days. Recently, the use of ultrasonic dissection of adult livers has revolutionised the transplantation of children and, should thus decrease the waiting period in the future.
1. Extra-hepatic malignancy. 2. Active alcoholism. 3. Extra-hepatobiliary sepsis. 4. Severe medical diseases e.g. renal/cardiac disease. 5. Multiple previous abdominal surgery.
6. Active hepatitis B (e antigen positive). 7. Aged greater than fifty five (55)
years. (N.B. A sixty six (66) year old male was successfully transplanted in 1987). 8. Pyschological instability.
TABLE 4
TABLE 5
OUTCOME OF PATIENTS ACTIVATED
CAUSE OF DEAm IN TRANSPLANT RECIPIENTS
(JANUAY 1986 - SEPTEMBER 1988) CURRENTLY WAITING
TRANSPLANTED
ADULTS CHILDREN
Air embolus Cerebal infarct Cerebral haemorrhage Viral infections Hypoxia Sepsis Secondary haemorrhage Chronic rejection Hyperacute rejection Intraoperative exsanguination
DIED WAITING
ADULTS
3
28
8
CHILDREN
3
9
3
TOTAL
6
37
11
31
1 1 2 1
1 1
2
1 3 1 1
CONFEDERATION OF AUSTRALIAN CRITICAL CARE NURSES JOURNAL
To September 1988, fourteen (14) patients have
ACKNOWLEDGEMENTS
died post-operatively of various complications and one (1) has died intra-operatively (Table 5).
The encouragement and assistance of the following Royal Prince Alfred Hospital staff of the Australian
Twenty (20) of the transplant recipients are either
National Liver Transplant Unit is gratefully
convalescing satisfactorily or leading normal lives,
acknowledged.
two (2) are currently receiving acute care for post-operative complications. Confirmation of the
G. Kyd, R.N., National Liver Transplant
quality of life post-transplantation is illustrated by
Co-ordinator
the fact that five (5) patients have returned to
R. Sloan, R.N., C.N.S. - Liver Diseases.
continue their education at either primary, secondary or tertiary level. Other recipients have returned to former occupations, taken up new
REFERENCES
employment or retired. One recipient is currently 1. KYD, G. (1987). The R.P.A.C.H./C.H.C. Liver
in the third (3rd) trimester of pregnancy. The five (5)
most recent transplant recipients are in good
Transplant Unit. R.P.A. Magazine Vol. 85, No.
health and convalescing in hospital or at home.
329, pp. 7.
2. HAWKER, F. (1988) Intensive Care Manual.
CONCLUSION
3rd Edition, (In press). The above review indicates that liver transplantation in Australia, although in its infancy, has been successful in prolonging the life of patients with end stage liver disease. The majority of recipients are leading productive, normal lives with enhanced quality of life. In the future there is need for increasing research and documentation of the recipients' morbidity to effectively monitor the success of the ANLTU programme.
32