Open AccessProgress in liver transplantation
Author(s) -
Putnam Charles W.,
Halgrimson Charles G.,
Koep Lawrence,
Starzl Thomas E.
Publication year - 1977
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/bf01665073
Subject(s) - medicine , liver transplantation , biliary atresia , contraindication , malignancy , transplantation , biliary tract surgical procedures , surgery , cirrhosis , gastroenterology , biliary tract , pathology , alternative medicine
Since the first clinical orthotopic liver transplant was performed 13 years ago, approximately 275 patients have undergone this procedure. The Denver series constitutes about 40% of this total experience. In our series, the overall 1‐year survival has been 29%; the longest survivor is now 6 2/3 years posttransplantation. Most of the early deaths have been caused by technical complications, frequently related to difficulties in establishing and maintaining adequate biliary drainage. The late deaths have been from a variety of causes, including recurrent tumor, hepatitis, bile duct obstruction, and chronic rejection. Favorable indications for liver transplantation include biliary atresia, chronic aggressive hepatitis, inborn errors of metabolism, and certain other benign hepatic diseases. Alcoholic cirrhosis is a less favorable indication and primary hepatic malignancy is a relative contraindication. The immunologic criteria for donor‐recipient selection are much less rigid than for renal transplantation. Biliary reconstruction is the principal technical problem encountered with orthotopic liver transplantation. Guidelines for the establishment of biliary drainage, its evaluation, and the management of postoperative biliary complications are discussed .