Introduction The majority of hepatobiliary injuries are managed nonoperatively, supported by tenets of patient selection, appropriately timed adjunct interventions, and careful monitoring. The liver is a well-vascularized solid organ (see Chapter 5 ), making hemorrhage a common cause of mortality…
Type 1 diabetes mellitus (DM), formerly known as “juvenile diabetes,” is characterized by hyperglycemia resulting from the nearly complete destruction of insulin-producing β-cells of the pancreatic islets of Langerhans. The loss of β-cells is the result of a T lymphocyte–mediated…
Liver transplantation (LT) has evolved from a high-risk procedure with significant morbidity and mortality to a standard treatment for patients with liver failure. Patients who undergo successful liver replacement have 1-year and 5-year survival rates that exceed 85% and 70%,…
Historic overview Thomas Starzl attempted the first human liver transplantation (LT) in 1963 in a 3-year-old child with biliary atresia (BA; see Chapter 125 ). Unfortunately, the child died in the operating room from uncontrollable hemorrhage. Just a few years…
Since the initial descriptions of successful deceased donor liver transplantation (LT) in the 1960s by Dr. Thomas Starzl (see Chapter 125 ), there has been tremendous change and growth in the field of transplantation. Advancements in organ preservation, immunosuppression, perioperative…
Overview Liver transplantation (LT) is considered standard of care for select patients with hepatocellular carcinoma (HCC) arising in the setting of cirrhosis (see Chapter 108A ). The role of LT in treatment of other malignancies arising in the liver such…
Cancer of a solid organ is an uncommon indication for organ transplantation, but hepatocellular carcinoma (HCC) is an important exception to that general rule (see Chapters 89 and 105 ). HCC is the most common tumor treated with whole-organ transplantation,…
Acute liver failure (ALF), formally known as fulminant hepatic failure, is a rare and devastating condition characterized by the development of encephalopathy and impaired synthetic liver function (international normalized ratio [INR] > 1.5) occurring within 26 weeks of acute-onset jaundice…
Introduction The Global Observatory on Donation and Transplantation estimates that more than 35,000 liver transplantations are performed annually worldwide, but the number of patients on the waiting list continues to exceed donor organ availability. Because of the continuous donor shortage,…
The first human orthotopic liver transplant was carried out by Starzl in 1963. In the subsequent two decades, only a relatively small number of patients received grafts, usually those who were moribund with end-stage disease, and survival results were disappointing.…