Fifteen years of clinical liver transplantation

Abstract

Liver transplantation in humans was first attempted more than 15 yr ago. The 1-yr survival has slowly improved until it has now reached about 50%. In our experience, 46 patients have lived for at least 1 yr, with the longest survival being 9 yr. The high acute mortality in early trials was due in many cases to technical and management errors and to the use of damaged organs. With elimination of such factors, survival increased. Further improvements will depend upon better immunosuppression. Orthotopic liver transplantation (liver replacement) is the preferred operation in most cases, but placement of an extra liver (auxiliary transplantation) may have a role under special circumstances.

Figure 1

Techniques of biliary duct reconstruction used for most of the transplantation recipients in the Colorado series. A. Cholecystoduodenostomy. This operation is no longer performed. B. Cholecystojejunostomy. C. Choledochojejunostomy after removal of gallbladder. D. Choledochocholedochostomy. Note that the T-tube is placed, if possible, in recipient common duct. (By permission of SURGERY, GYNECOLOGY & OBSTETRICS 142:487, 1976.)

Figure 2

Transhepatic cholangiogram 4 yr after liver transplantation for alcoholic cirrhosis (OT 82). Cholecystoduodenostomy was used for biliary drainage. The obstruction was at the cystic duct, which cannot be seen well. The intrahepatic ducts are almost normal, but there is a definite dilatation of the common duct including the blind sac distal to the cystic duct entrance (arrow). The patient presented with fever, jaundice, and gram negative bacteremia. The diagnosis was cholangitis. Cholecystoduodenostomy was converted to Roux-Y choledochojejunostomy.

Figure 3

Transduodenal cholangiogram in an alcoholic patient (OT 102) who received a liver 2 yr ago with choledochocholedochostomy. The T-tube was left in for 1 yr, and the cholangiogram was obtained 6 mo after its removal.

Figure 4

Transhepatic cholangiogram 14 mo postoperative in a 12-yr-old patient (OT 126) who received an orthotopic liver transplant 15 mo previously. Biliary reconstruction initially was with cholecystojejunostomy (see Figure 1B). Twelve months postoperatively, this was converted to choledochojejunostomy (see Figure 1C). The cholecochojejunal anastomosis is marked with an arrow. J = jejunum.