Dr. Thomas Starzl joined the faculty at the University of Colorado as the Chief of Surgery at the Denver Veterans Administration Medical Center (VAMC) in 1961. He performed the first kidney transplant in March of 1962. Dr. Starzl pioneered liver transplant with the first attempt on March 1st of 1963. With Dr. Starzl’s departure to Pittsburgh, the Liver Transplant Program was closed at the University of Colorado until November 1988. The new era started on July 1st, 1988 with the arrival of Dr. Igal Kam, an Israeli transplant surgeon who spent two years with Dr. Starzl in Pittsburgh. Dr. Kam completed his two years of fellowship with Dr. Starzl and became a faculty member in Pittsburgh in 1985.

Upon Dr. Kam’s arrival to the University of Colorado, he immediately recognized the need to build a multidisciplinary team combined of surgeons, hepatologists and nephrologists. Together with the hospital commitment a team was created with nursing and a designated hospital space for the new transplant unit.

With better outcomes in liver transplant more programs appeared in the United States and other parts of the world.

At the University of Colorado the initial team efforts gave them experience in 10 cases with no death paved the road to the success of the team.

After completion of the first series of 110 cases with veno-venous by-pass, we had trouble with case number 111. We were unable to introduce the veno-venous by-pass. The case was completed without the bypass and as a result we gradually terminated the use of the by-pass between 1992-1995. Since 1995, veno-venous by pass has not been used at the University of Colorado during liver transplant surgery.

Around the same time the use of T-tube in liver transplant was stopped. This small change significantly reduced the hospital stay for patients after liver transplant.

The next step of practice change was obtained with early extubation. As a result of the elimination of veno-venous bypass we changed the intraoperative management of liver transplant patients. The use of more vasopressors and less fluids was used. Over 70% of our recipients including some of the very sick patients are extubated. Most of these patients do not need SICU post liver transplant.

With the increased numbers of patients on the waiting list for liver transplant in the U.S., the Scientific Registry of Transplant Recipients (SRTR) reports indicate that in some centers including ours that the one year wait list mortality reaches the level of more than 10%. As a result we began our live donor liver transplant (LDLT) program. Positive outcomes from Japan stimulated our efforts. We decided to use of the right lobe of the liver instead of the left one.

The University of Colorado Transplant Program in 1997, was the first one in the western hemisphere to report the initial success of the Right lobe liver donor transplant. The controversy surrounding LDLT continues in the US and other countries especially regarding the donor safety. In Colorado we had a donor death after 140 LDLT. The impact of a death on the family of the donor and on the transplant team is devastating.

The last technical modification was in 2000; with the reintroduction of choledochoduodenostomy instead of a roux-en-y anastomosis. This technical change was first used in hostile abdomens when roux-en-y limb was difficult to create.

In the mid 1990’s we started protocols of steroid withdrawal after liver transplant which has led to complete cessation of steroid use after liver transplant except for some of the autoimmune hepatitis cases. We also achieved better results with Denovo use of Rapamycin after liver transplant

Over the last 25 years our program has done over 1800 liver transplants in adult and pediatric patients with over 90% one year patient survival and one over 70% for ten years.

To conclude; the team effort and need for improvement was the driving force behind the coordinated success of the liver transplant program at the University of Colorado School of Medicine.