Fifteen years of clinical liver transplantation

Starzl, Thomas E.; Koep, Lawrence J.; Halgrimson, Charles G.; Hood, John; Schröter, G; Porter, Kenneth Wiggins; Weil, Richard

doi:10.1016/0016-5085(79)90294-4

Cited by 169 publications

(82 citation statements)

References 28 publications

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“…Despite the tolerogenic property of the liver allograft [12,13,[26][27][28][29][30][31][32], the incidence of rejection is common in human recipients (50-75%). This may be reversed by aggressive or long-term immunosuppression therapy, but its complications (80% developing renal dysfunction, 75% hypertension, 50% hyperlipidemia, and 20-25% new-onset diabetes mellitus) [25] continue to be major clinical challenges.…”

Section: Liver Tolerogenicitymentioning

confidence: 99%

Stellate Cells in Hepatic Immunological Tolerance

Gandhi

2015

Stellate Cells in Health and Disease

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Section: Liver Tolerogenicitymentioning

confidence: 99%

Stellate Cells in Hepatic Immunological Tolerance

Gandhi

2015

Stellate Cells in Health and Disease

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“…As a result, methods of re-establishing bile drainage have been revised since the first operation in 1963 when the Denver group utilized cholecystoduodenostomy [3,4]. Although the procedure was considered relatively simple to perform, obstruction of the cystic Cholecystojejunostomy is used to surgically reconstruct the biliary duct following liver transplantation: L, liver; GB, gallbladder; CBD, common bile duct; J, jejunum; D, duodenum; PV, portal vein; and HA, hepatic artery duct from biliary sludge and/or inflammatory changes occurred often, and bile fistulas also were common [3,4].…”

Section: Discussionmentioning

confidence: 99%

“…Today a choledochocholedochostomy with a Ttube stent is the ideal biliary reconstruction [4], but often is not feasible (e.g., in children with biliary atresia). As an alternative approach, a cholecystojejunostomy to a defunctionalized Roux-en-Y loop is employed to establish biliary drainage (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…As an alternative approach, a cholecystojejunostomy to a defunctionalized Roux-en-Y loop is employed to establish biliary drainage (Fig. 2) [3,4]. This type of surgery is preferable to cholecystoduodenostomy because it uses a large-caliber anastomosis with a defunctionalized bowel, thus affording some protection against infection.…”

Section: Discussionmentioning

confidence: 99%

“…Regardless of the type of anastomosis, biliary sludge has been a troublesome problem [2,4,7,9,10]. Two types o f biliary sludge are recognized.…”

Section: Discussionmentioning

confidence: 99%

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Obstructive jaundice as a long-term complication in a patient with liver transplantation

Boll

Thoeni

1981

Gastrointest Radiol

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Obstructive jaundice related to stricture and stone in cystic duct was found in a patient 6 years after liver transplantation and cholecystojejunostomy. Complications with biliary drainage following liver transplantation are discussed. In the presence of dilated ducts seen by ultrasound, percutaneous transhepatic cholangiography performed immediately can lead to surgical correction, thus preventing failure of the liver transplant.

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Decline in Survival After Liver Transplantation

Starzl¹

1980

Arch Surg

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Twenty-three recent cases of orthotopic liver transplantation were individually reviewed in an effort to determine why survival had declined from the 50% one-year survival rate of an immediately precedent series. In the series of 23, only six (26%) achieved one-year survival. Faulty case selection, technical complications, the use of damaged organs, and complications of immunosuppression were the main causes of death. Attention was directed to the possible use of preoperative lymphoid depletion to improve the effectiveness and safety of immunosuppression. Our total experience with orthotopic liver transplantation up to January 1978 has been reported 1 with a minimum potential follow-up of at least one year for every recipient. As these 141 cases were compiled there was a slow improvement in the one-year survival rate, which in the last 30 patients reached the 50% level. We report here a subsequent, less encouraging experience in 23 more consecutive cases. An analysis of these recent patients was undertaken to determine the reasons for the recent increase in mortality, and to consider further policy changes in case selection and management from which to mount renewed efforts. CASE MATERIAL AND METHODS Underlying Liver Disease The Table gives information on the 23 cases. There were 12 adults and 11 children. Among the adults the most common diagnosis was chronic aggressive hepatitis (six examples). Two patients with sclerosing cholangitis had had previous operations, and one (orthotopic transplant [OT] patient 149) had a residual duodenal fistula. There was one example each of protoporphyria, secondary biliary cirrhosis from an old choledochal cyst, primary biliary cirrhosis, and alcoholic cirrhosis. Of the five children with biliary atresia, three had undergone unsuccessful Kasai procedure. Four children had alpha 1-antitrypsin deficiency and one had congenital hepatic fibrosis. The final pediatric patient was a 15-year-old girl (OT 150) whose duct system had been excised five years previously during right hepatic lobectomy for trauma. Repeated attempts at duct

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Fifteen years of clinical liver transplantation

Cited by 169 publications

References 28 publications

Stellate Cells in Hepatic Immunological Tolerance

Stellate Cells in Hepatic Immunological Tolerance

Obstructive jaundice as a long-term complication in a patient with liver transplantation

Decline in Survival After Liver Transplantation

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