Evolution of Liver Transplantation Program in Shiraz, Iran

Background: Liver transplantation (LT) is the only approved treatment for patients with end stage liver disease (ESLD). Shiraz organ transplantation center (SOTC) was the first center in Iran to provide LT. This report is on the evolution of LT program in this center. Methods: We report the clinical features and outcomes of all those who received LT between May 15, 1993 to December 31, 2015 as well as donor features. All LT were performed at Namazi hospital in Shiraz, Iran. The Kaplan-Meier and multivariate Cox proportional hazards regression analyses were performed to determine prognostic factors and the overall long-term survival after liver transplantations. Results: During this period, 3191 recipient patients received LT from 3110 donors. Overall patient survival rates were 84% at 1 year, 80% at 5 years, and 73% at 10 years. The survival rates for recipients from living donors were 74.0% at 1 year and 70.0% at 5 years compared to 86.0% at 1 and 81.0% at 5 years for recipients from deceased donors (P < 0.0001). The survival rates of LT for 2 different Era I (1993 - 2005) and II (2006 - 2015) were estimated to be 76.0% vs. 85.0% at one year, 69.0% vs. 81% at 5 years, and 60.0% vs. 78.0% at 10 years, respectively (P < 0.0001).The most common indications for LT were cryptogenic cirrhosis, hepatitis B, primary sclerosing cholangitis, autoimmune hepatitis, and metabolic liver diseases during this period. Conclusions: LT is now an affordable treatment for patients with ESLD in Iran with acceptable survival, which has further been improved in recent years.