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.…
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)…
As discussed in Chapter 69 , there are various potential severe surgical and medical complications that may occur immediately after liver transplantation. Once a patient has been transferred out of the intensive care unit, the focus shifts more to rehabilitation,…
Nowhere else in the realm of liver transplantation have both the advances made in the field and the realities of the surgery been more evident than in the intensive care unit (ICU). The impact of the Model for End-Stage Liver…
Necrotic liver tissue, whether before or after liver transplantation, is a serious condition that requires immediate attention, because it can result in considerable morbidity or mortality. Although the most effective treatment for a massively necrotic liver is liver replacement, the…
Irreversible kidney failure was once considered an absolute contraindication to liver transplantation alone. Three decades ago the first combined liver and kidney transplantation (CLKT) was performed by Margreiter et al. Interestingly, the recipient, a 32-year-old man with hepatitis B cirrhosis, had…
According to conventional clinical and surgical standards of the early 1960s, removal of a diseased liver and replacing it with a working, undamaged one was a concept that, although visionary and sound, had a low probability of being successfully executed.…
Fifty years have passed since the first liver transplantation was performed by Thomas E. Starzl. Orthotopic liver transplantation (OLT) has become the recommended treatment in patients with hepatocellular carcinoma (HCC) and cirrhosis, as well as for other selected tumors. This…
The history of liver transplantation is a complicated story to tell—it is a story of great successes and tragic failures. It is a story of both individual heroics and the power of collaboration. It is a story that has many…