ORTHOTOPIC LIVER TRANSPLANTATION FOR WILSON???S DISEASE

• DOI: 10.1097/00007890-200110150-00008
• Publication Date: 2003-12-02T11:14:05Z
• Authors: Sukru Emre; Evren O. Atillasoy; Sebati Ozdemir; Michael Schilsky; C.V.R. Rathna Varma; Swan N. Thung; Irmin Sternlieb; Stephen R. Guy; Patricia A. Sheiner; Myron E. Schwartz; Charles M. Miller
• Keywords: Adult; Male; Graft Survival; Middle Aged; Severity of Illness Index; Survival Analysis; Liver Transplantation; 3. Good health; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Hepatolenticular Degeneration; Liver; Child, Preschool; Chronic Disease; Humans; Female; Child; Retrospective Studies

Wilson's disease is an inherited disorder of copper metabolism characterized by reduced biliary copper excretion, which results in copper accumulation in tissues with liver injury and failure. Orthotopic liver transplantation (OLT) can be lifesaving for patients with Wilson's disease who present with fulminant liver failure and for patients unresponsive to medical therapy. The aim of this study is to review our experience with OLT for patients with Wilson's disease.Between 1988 and 2000, 21 OLTs were performed in 17 patients with Wilson's disease. Patient demographics, pre-OLT laboratory data, operative data, and early and late postoperative complications were reviewed retrospectively. One-year patient and graft survival was calculated.Eleven patients had fulminant Wilson's disease; in six patients the presentation was chronic. Mean patient age at presentation was 28 years (range 4-51 years); mean follow-up was 5.27 years (range 0.4-11.4 years). Neurologic features of Wilson's disease were not prominent preoperatively and did not develop post-OLT except in one patient who developed acute neuropsychiatric illness and seizure. Renal failure, present in 45% of patients with fulminant Wilson's disease, resolved post-OLT with supportive care. One-year patient and graft survivals were 87.5% and 62.5%, respectively. Fifteen survivors have remained well with normal liver function and no disease recurrence.Liver transplantation for hepatic complications of Wilson's disease cures and corrects the underlying metabolic defect and leads to long-term survival in patients who present with either acute or chronic liver disease. Acute renal failure develops frequently in patients with fulminant Wilsonian hepatitis and typically resolves postoperatively.