Liver transplantation for Wilsonʹs disease

As has been the case with other metabolic diseases of the liver in the last decade, orthotopic liver transplantation has been applied to the treatment of Wilsonʹs disease with increasing frequency. The experience at the University of Pittsburg with orthotopic liver transplantation for Wilsonʹs disease is reported. Methods: Between February 1981 and December 1991, 51 orthotopic liver transplants were performed on 39 patients (16 pediatric, 23 adults) with Wilsonʹs disease. Twenty-two patients were transplanted because of a presentation co-existent with fulminant hepatic failure. Seventeen presented with chronic advanced liver disease with (n=9) or without (n=8) associated neurologic dysfunction. Results: The rate of primary graft survival (n-39) was 73% and patient survival was 79.4%. No patient mortality occurred beyond 3 weeks post-orthotopic liver transplantation. Survival was better for those with a chronic advanced liver disease presentation (90%) than it was for those with a fulminant hepatic failure (73%) presentation, but the difference was not statistically significant. Conclusions: 1) Currently, orthotopic liver transplantation is the treatment of choice for Wilsonʹs disease presenting as fulminant hepatic hepatic failure; 2) orthotopic liver transplantation should be considered for patients with Wilsonʹs disease with advanced, chronic liver disease for whom no other therapy is possible; 3) orthotopic liver transplantation only partially corrects the underlying metabolic defect of patients with Wilsonʹs disease and converts the copper kinetics from that characteristic of an individual affected with a homozygous disease to that of an individual who is an obligate heterozygote, thereby effecting a phenotypic cure.