Extended survival in 3 cases of orthotopic homotransplantation of the human liver

Abstract

There have been 9 reported attempts of orthotopic homotransplantation of the human liver-7 in Denver 16,21,22 and one each in Boston 11 and Paris. 5 Survival time was 0 to 23 days. There were multiple reasons for death in each case, but in most an important factor was either the failure to obtain good immediate liver function or the inability to subsequently maintain such function.On July 23 and 31, Sept. 5, and Oct. 8, 1967, 4 more orthotopic liver transplantations were performed in our institutions. The recipients are at the time of this writing 94, 86, 49, and 14 days postoperative. This report is concerned with the first 3 of these patients and with the improvements in therapy which were brought to these cases. In addition, attention will be directed to a number of serious and previously unrecognized problems which were encountered. The diagnosis and treatment of these complications will be presented, as well as some thoughts about how they might be prevented in future cases. OBSERVATIONS Case materialThe 3 recipients (hereafter called Patients 1 to 3) were 19, 20½, and 13 months old and weighed 10.8, 8.7, and 9.4 kilograms. All were girls. The diagnosis of nonresectable hepatic-cell carcinoma was made in Patient 1 at an abdominal exploration when she was 13 months old. During the next 5 months, the tumor had grown inexorably despite liver irradiation with a total of 975 r and systemic therapy with actinomycin-D, cyclophosphamide, methotrexate, and 5-fluorouracil. Liver function was normal. ADDENDUMTwo of the 3 patients in this series are still alive as of January 27, 1968. Patient 1 has now survived for more than 6 months. Liver function remains excellent, but she has developed slow-growing pulmonary metastases. Patient 3 will be 5 months postoperative in 1 week. Patient 2, who had poor liver function at the time the report was submitted, died after 134 days. The immediate cause of death was massive intestinal gangrene. Two more infants with biliary atresia have received orthotopic homotransplantation. The first died 61 days after transplantation as a consequence of thrombosis of the right hepatic artery and gangrene of the liver lobe. The second child is more than 2 months postoperative and has not had any of the complications described in the text. Drs. Pierre Daloze of Montreal and Claude Huguet of Paris were important members of the operating teams. Drs. Anthony Aldrete, Theodore Gingrich, and David LeVine provided the anesthesia. Three medical students made important contributions to the postoperative care of the patients; The homograft donorsThe donors for Patients 1 to 3 were 18 months, 4 years, and 18 months old and weighed 6.4, 13.0, and 8.2 kilograms. The first was a boy and the second and third were girls. The red-cell types of the 3 donors were the same as those of the recipients, namely O, O, and A.The condition of the donors was hopeless at the time of admission to the hospital because of brain damage and apnea. One was a microcephalic who had been resuscitated from a postaspiration cardiac ...

Changes in Serum Haptoglobin and Group Specific Component after Orthotopic Liver Homotransplantation in Humans

“…Three of the 4 children are still alive, now 180, 136, and 56 days after operation; the fourth died 61 days posttransplantation. A more general account of these cases is published elsewhere (5). Serum samples were taken from both the donors and recipients prior to transplantation; in Case 1, the parents' sera were also analyzed in order to confirm the Hp genotype.…”

The History of Liver Transplantation in Turkey

“…1 Subsequently, the first successful kidney transplant was performed between identical twins, 2,3 and the first successful deceased-donor liver transplant was performed in 1967. 4 After these successful operations, organ transplantation progressed rapidly and became the definitive treatment for end-stage organ diseases.…”

There is plenty for everyone: Transection of the infracardiac inferior vena cava during organ recovery

“…Since the first successful heart and liver transplants were described by Barnard 1 and Starzl et al 2 in the 1960s, proper transection of the IVC has steadfastly remained an important issue. Recent advances in modern heart transplant techniques, including the bicaval anastomotic technique, have obligated the cardiac recovery team to include a segment of the IVC with its specimen to provide an adequate length for anastomosis.…”