Liver transplantation--1978

Abstract

The development of liver transplantation has been made difficult because of the enormous technical difficulties of the procedure and because the postoperative management in early cases was defective in many instances. With surgical and medical improvements, the prospects for success have markedly increased recently. The wider use of thoracic duct fistula as an adjuvant measure during the first 1 or 2 postoperative months is being explored.

Fig. 1

Techniques of biliary duct reconstruction acceptable to us for most transplantation recipients. (A) Choledochocholedochostomy. Note that the T-tube is placed, if possible, in recipient common duct. (B) Cholecystojejunostomy. (C) Choledochojejunostomy after removal of gallbladder.

Fig. 2

Cholangiogram obtained 4 months postoperatively by the retrograde endoscopic technique. Reconstruction was with choledochocholedochostomy (Fig. 1 A). The T-tube was removed by the patient after 1 month. Note the low-grade anastomotic stricture (arrow).

Fig. 3

The course of a patient treated with thoracic duct drainage after orthotopic liver transplantation for primary biliary cirrhosis. Note that azathioprine, prednisone, and antithymocyte globulin (ATG) provided basic immunosuppression. The two rejections were mild and easily controlled with steroids.