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. 1968 Apr;63(4):549-63.

Extended survival in 3 cases of orthotopic homotransplantation of the human liver

T E Starzl, C G Groth, L Brettschneider, J B Moon, V A Fulginiti, E K Cotton, K A Porter

Extended survival in 3 cases of orthotopic homotransplantation of the human liver

T E Starzl et al. Surgery. 1968 Apr.
No abstract available

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Figures

Fig. 1
Fig. 1
Technique of orthotopic liver transplantation. Left, method used in Patients 1 and 3. Note that the celiac axis (or alternatively the common hepatic artery) of the homograft is anastomosed to the proper hepatic artery of the recipient patient. With this distal location in the recipient vessel the requisite dissection is considerably simplified. Right, reconstruction used in Patient 2. The right hepatic arterial branch of the homograft originated from the superior mesenteric artery and the left branch from the celiac axis (A). The vessels were individually attached to the 2 terminal branches of the host proper hepatic artery (B). In all 3 cases internal biliary drainage was with a cholecystoduodenostomy.
Fig. 2
Fig. 2
Course of Patient 1. Note the high rise in SGOT and SGPT at the time the septic liver infarction was diagnosed. The septicemia, indicated by encircled crosses, was with E. coli or Aerobacter-Klebsiella. The patient’s present condition is excellent.
Fig. 3
Fig. 3
Course of Patient 2. Note the rapid clearing of the pre-existing hyperbilirubinemia. The hepatic infarction which occurred early was probably on a technical basis. The positive blood cultures were all Bacteroides fragilis. Note the instability of liver function throughout the entire postoperative period, which makes longterm prognosis extremely guarded.
Fig. 4
Fig. 4
Course of Patient 3. Note the normal SGOT and SGPT levels which evolved after the injury. These rose again with the development of a septic infarct. All the positive blood cultures had Aerobacter-Klebsiella; the first one also contained E. coli.
Fig. 5
Fig. 5
Post-transplantation liver scans in Case 1, performed with technetium-99m sulfide. For each examination an anteroposterior view is shown above and a lateral view below. A, 17 days; there are no defects B, 29 days; large nonvisualizing areas are evident (arrows). C, 32 days; 48 hours after debridement of the affected necrotic areas. D, 78 days; showing extensive regeneration into the previous defects.
Fig. 6
Fig. 6
Serum proteins after liver homotransplantation in Patient 1. There was a significant increase in gamma globulins beginning one month after operation. Note the maintenance of normal coagulation factors II and V.
Fig. 7
Fig. 7
Serum proteins in Patient 2. Extreme late hypergammaglobulinemia is evident. Note the subnormal clotting factors at all times after the third postoperative week. The defects of protein metabolism in this patient correlated with the instability of other measures of liver function which are illustrated in Fig. 3.
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References

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