Results of Liver Transplantation at the Cuban Center for Medical and Surgical Research L. González-Rapado, A. Abdo, H. Hernández, M. Cepero, M. Samada, L. Ramos, R. Ysla, F. Gómez, D. Delgado, K. Melián, C. González, J. Pérez, and A. Bernardos ABSTRACT From July 4, 1999, when a liver transplantation program was started in Cuba, to December 30, 2007, we performed 125 procedures in 115 patients. The most frequent reasons for transplan- tation were cirrhosis caused by hepatitis C virus (29%) and alcoholic cirrhosis (17.2%). Two patients received simultaneous liver-kidney transplants. Sixty-seven patients were males, and the patient ages ranged from 12 to 74 years. The average surgical time was 6 hours, and cold ischemia time was 4 to 14 hours. The average blood consumption was 1630 mL; 2900 mL of plasma and 8 units of platelets were used in 7 cases. Immunosuppression was mainly cyclosporine, mycophenolate mofetil, and prednisone. Acute cellular rejections were treated in almost all cases with 3 doses of methylprednisolone. The most frequent complications were biliary (15%), hepatic arterial thrombosis (6%), postsurgical bleeding (8%), acute cellular rejection (20%), and ductopenic rejection (2%). The overall 1-year survival was 74.7%. A FTER THE FIRST liver transplantation in 1963, many in the medical community thought good results would be difficult. But technical advances over the following years led to the possibility of starting successful programs, mainly in the First World countries. The first successful liver transplantation in Cuba was performed on July 17, 1987, although the liver transplantation program proper did not start until July 4, 1999. 1 From then until December 30, 2007, we performed 125 orthotopic liver transplantations (OLT). For Third World countries, starting and maintain- ing one of these programs is extremely challenging, mostly for economic reasons. Herein, we have presented the results of our program over the first 8 years. MATERIALS AND METHODS We reviewed the clinical charts of 125 patients who underwent OLT from July 1999 to December 2007, collecting the medical, surgical, and postsurgical data related to the procedures. RESULTS We performed 125 liver transplantations in 115 patients from July 1999 to December 2007. Two procedures were simultaneous liver-kidney transplantations, and 10 were retransplantations. Sixty-seven patients were males and 48 females. The most common reason for transplantation was noncholestatic advanced chronic liver disease, mainly from cirrhosis caused by hepatitis C virus (29%) and alcoholic cirrhosis (17%). Piggyback surgery was performed in 99% of the cases. No venovenous bypass was used. Biliary tract reconstruction was undertaken using 1 of 3 techniques. The first, in 47 cases, was choledochocholedochostomy (CCS) with a T tube, with complications in 17%. The second was the same CCS but without a T tube and with a tutor in 32 cases. This technique was associated with complications in 24.5%. In the last 46 cases, we introduced the CCS without a tutor, with complications in 15%. Finally, hepaticojeju- nostomy was used in 5 patients when the other techniques were not feasible for anatomic reasons or because of causes related to the underlying hepatobiliary disease. Vascular complications included hepatic arterial thrombosis (6%) and suprahepatic venous thrombosis (2%). Nine patients (8%) required another operation to treat hemorrhage in the early postsurgical period. Acute cellular rejection was noted in 24.2% of patients, 43.75% of whom had hepatitis C virus. We performed 12 pediatric transplantations be- cause of autoimmune cirrhosis in 8 cases and cryptogenetic cirrhosis, Wilson disease, Budd-Chiari syndrome, and Caroli syndrome in 1 patient each. Two transplants crossed a minor ABO incompatibility. The median consumption of From the Medical-Surgical Research Center, Havana City, Cuba. Address reprint requests to Dr Leonel González, Medical- Surgical Research Center, Av 216 e/11-13, Siboney, Playa, Ciudad Habana, Cuba. © 2008 Published by Elsevier Inc. 0041-1345/08/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2008.09.037 Transplantation Proceedings, 40, 2983–2984 (2008) 2983