Although experimental attempts at most solid organ transplants can be traced to the early 1900s, experimental liver transplantation was not performed until 1952 when Vittorio Staudacher performed an orthotopic liver transplant in a dog model. In 1963, Thomas Starzl performed the 1st human orthotopic liver transplant. Although this patient died, Dr. Starzl was successful in transplanting a young child in 1967 who lived over one year. Although several other surgeons including professors Calne, Bismuth and Pichlmayr in the late 1960s through the late 1970s had modest success in liver transplantation, it was not till the discovery and use of calcineurin inhibitor immunosuppression in the late 1970s-early 1980s that liver transplantation was considered a justifiable and truly therapeutic treatment for patients with end stage liver disease.
As an example, in 1984 there were 5 liver transplant centers in the US, while today, there are over 130. With the development and standardization of surgical techniques, organized organ procurement strategies and teams, improved organ preservation, as well as immunosuppression protocols, liver transplantation has become universally accepted as the definitive therapy for patients suffering from liver failure of all causes.
Today in most experienced centers, liver transplantation results in approximately 85%, 75% and 60% 1, 5, and 20 year patient survival. In general pediatric patients fare better than adults and even the sickest patients, with MELD scores of 40 or greater can achieve a better than 70% long term survival. Despite these amazing results of long term survival in patients with end stage liver disease or primary hepatocellular carcinoma, complications with immunosuppression and recurrent disease continue to remain problematic.
In the future these are the major goods which need to be addressed:
Volume : 11
Issue : 6
Pages : 4
William P. Longmire Jr. Distinguished Professor
Executive Chairman, Department of Surgery
Ronald Reagan UCLA Medical Center
Division of Liver and Pancreas Transplantation
David Geffen School of Medicine at UCLA, USA