Liver transplantation: an unfinished product

Abstract

Liver transplantation has become an extraordinarily valuable and useful operation, but one that is not perfect and that has not been exploited to anything like its full potential. Better immunosuppression may become available soon as exemplified by developments with the Japanese drug, FK506. Improved preservation with the UW solution is already here. With these advantages, liver transplantation is certain to become far more widely used than at any time in the past. Examples were cited of innovative approaches using liver transplantation for the treatment of hepatic malignancies.

Fig 1

Liver transplantation by year at the University of Colorado (through 1980) and the University of Pittsburgh (1981, onward).

Fig 2

Actuarial survival of orthotopic liver recipients in the precyclosporine era (1963-1979) and after the introduction of cyclosporlne-steroid therapy In early 1980 (1980-1987).

Fig 3

Survival curves of patients who were B-virus carriers, or whose reasons for transplantation was hepatic malignancy.

Fig 4

Results of treatment of a B-virus carrier with human monoclonal HBIgG before and after orthotopic liver transplantation. The surface antigen titers were measured with a sandwich technique, using a gamma counter. Hepatitis B antigen was eliminated from the blood after administration of monoclonal antibody.

Fig 5

CAT scan in a patient with a spindle cell sarcoma of the duodenum whose liver, pancreas, spleen, total stomach, ascending colon and transverse colon were removed en bloc. The replacement organs are shown in Figure 6. Note the Involvement by tumor metastases of all segments of the liver and cavitation of a dominant mass In the right lobe.

Fig 6

Reconstruction after removal of upper abdominal organs en bloc including the liver, total pancreas, spleen, colon and all or part of the stomach. The homograft organ clusters are shaded. Left—The patient had sclerosing cholangitis and cholangiocarcinoma of the distal duct. Right—The patient had spindle cell sarcoma of duodenum with massive liver metastases (see Fig 5).