The continued success of liver transplantation over the past quarter century can be attributed to a number of factors: better understanding of disease pathophysiology, enhanced intraoperative management, and improved posttransplantation care, to name a few. Atop this list, however, is…
Historical Perspective The development of potent immunosuppressive therapies transformed liver transplantation from the experimental procedure pioneered by Thomas Starzl and Sir Roy Calne into the preferred clinical treatment for end-stage liver disease. The greatest incremental improvements in clinical outcomes have…
The introduction of more potent immunosuppressive agents in the 1990s resulted in a reduction of acute rejection and graft loss. However, the improved short-term success has translated into only modest gains in long-term renal allograft survival. The main cause of…
Orthotopic liver transplantation (OLT) for malignancy, specifically hepatocellular carcinoma (HCC), has dramatically increased in the last several decades. Unfortunately, cancer recurrence remains a formidable problem. At present, calcineurin-based immunosuppression (IS) regimens are employed by most transplant centers around the world.…
Advances in the treatment of rejection have mirrored the evolution of liver transplantation. In the earliest days of transplantation, clinical outcomes were marred by fatal complications related to ischemia, preservation injury, surgical technique, and infection. Grafts that would survive long…
The admonition that “children are not small adults” is well justified in the immunosuppressive management of children after liver transplantation. When compared with adults, several key differences are apparent when considering immunosuppression for children: Children are more immunoresponsive than adults.…
Progress in liver transplantation in essence has been a story of the progress in developing immunosuppressant drugs. Although initial attempts at liver transplantation in Denver and Cambridge in the 1960s and 1970s using azathioprine, steroids, and antilymphocyte globulin had some…
Graft-versus-host disease (GVHD) occurs when histoincompatible lymphocytes from an allogenic donor engraft in a transplant recipient. GVHD is frequent after bone marrow transplantation but relatively rare after liver transplantation. GVHD typically occurs 1 to 6 weeks after liver transplantation (LT)…
The ABO blood group antigens and the human leukocyte antigens (HLA) encoded by the major histocompatibility gene complex represent substantial barriers to transplantation of tissues and organs between individuals. The antigens of these two systems are expressed on most cells…
Between 1953 and 1956, a strong association between donor leukocyte chimerism and acquired donor-specific tolerance was demonstrated in studies of mouse models. Bone marrow transplantation a dozen years later in immune-deficient and cytoablated human recipients was a logical extension. In…