A brief history of liver transplantation and transplant anesthesia

Abstract

In this review, we describe the major milestones in the development of organ transplantation with a specific focus on hepatic transplantation. For many years, the barriers preventing successful organ transplantation in humans seemed insurmountable. Although advances in surgical technique provided the technical ability to perform organ transplantation, limited understanding of immunology prevented successful organ transplantation. The breakthrough to success was the result of several significant discoveries between 1950 and 1980 involving improved surgical techniques, the development of effective preservative solutions, and the suppression of cellular immunity to prevent graft rejection. After that, technical innovations and laboratory and clinical research developed rapidly. However, these advances alone could not have led to improved transplant outcomes without parallel advances in anesthesia and critical care. With increasing organ demand, it proved necessary to expand the donor pool, which has been achieved with the use of living donors, split grafts, extended criteria organs, and organs obtained through donation after cardiac death. Given this increased access to organs and organ resources, the number of transplantations performed every year has increased dramatically. New regulatory organizations and transplant societies provide critical oversight to ensure equitable organ distribution and a high standard of care and also perform outcome analyses. Establishing dedicated transplant anesthesia teams results in improved organ transplantation outcomes and provides a foundation for developing new standards for other subspecialties in anesthesiology, critical care, and medicine overall. Through a century of discovery, the success we enjoy at the present time is the result of the work of well-organized multidisciplinary teams following standardized protocols and thereby saving thousands of lives worldwide each year. With continuing innovation, the future is bright.

Invasive Fungal Infections after Liver Transplantation

“…Ever since the first liver transplant in 1963, orthotopic liver transplantation has become a life-saving standard of care treatment for end-stage liver diseases and malignancies [1]. Improvements in surgical techniques, organ preservation, immunosuppression, and critical care have pushed the one-year survival rates up to 90%, with a 10-year survival rate of more than 60% [2][3][4][5][6][7].…”

Effect of dexmedetomidine on liver transplantation: a meta-analysis

“…Perioperative hemodynamic stability during LT has a positive impact on graft function and patient recovery ( Sharma et al, 2022 ). Dexmedetomidine (DEX) is a high-efficiency and high-selectivity alpha-2 adrenaline receptor agonist.…”