Clinical Liver Transplantation

During the last two years., there has been increasing evidence that liver transplantation will have an important role in the treatment of otherwise fatal human hepatic disease (Calne & Williams 1968, Calne ei al. 1968, Starzl & Putnam 1969, Starzl et al. 1968, 1969a/b). The optimism that has infected workers in this field needs little other justification than the fact that 5 patients have already lived for more than a year after removal of their diseased liver and its replacement (orthotopie transplantation) with a cadaveric homograft (Starzl & Putnam 1969). At a symposium convened by Professor Roy Calne in early April, 1969, at Cambridge, England, it was noteworthy that survival of at least a month after this kind of operation was reported from seven different centers in widely separated cities of the world (Boston, Cambridge, Denver, Louvain, Minneapolis, New York, and Paris). It will not be the purpose of the present communication to dwell upon such encouraging aspects of these clinical endeavors. Instead an attempt will be made to analyze the causes for the morbidity and mortality that have so far remained at an unacceptably high level. In so doing, the greatest attention will be focused upon problems encountered and observations made in our first 26 human recipients of orthotopie liver transplants who were treated between 1 March 1963 and 11 May 1969; the interested reader is also urged to consult Calne's important reports on the Cambridge series (Calne & Williams 1968, Calne et al. 1968). Additional comments will also be