Liver transplantation in the adult

Abstract

A total of 216 orthotopic liver transplants have been carried out in the Cambridge/King's College Hospital series. Over 16 years, changes in patient selection, immunosuppression, and surgical and anesthetic techniques have led to an improvement in results. These aspects are described and discussed. Although at considerable risk during the operation, patients with nonmalignant cirrhotic diseases who survive 1 year have a good long‐term chance of survival. A slow but steady improvement in survival after liver grafting has resulted from multiple and interesting factors. These include patient selection, technical changes, particularly regarding biliary drainage, increased availability of donors with transport of livers between different centers, and new immunosuppressive management. Although patients with primary carcinoma of the liver are better operative risks, the incidence of recurrent growth is about 60%. Patients with nonmalignant cirrhotic disease are more apt to develop perioperative complications. If they survive the first few weeks, their chances of long‐term rehabilitation are better than those of patients with malignant conditions. Many of the earlier patients in our series would now be considered too ill for the procedure, but still patients accepted for grafting die before a donor liver becomes available, and some patients who are suitable when first seen are gravely ill by the time a liver graft can be performed. The results and experience gained from the 216 orthotopic liver transplants performed in our series from May 1968, to August 1985, are described.

Normalization of ventilation/perfusion relationships after liver transplantation in patients with decompensated cirrhosis: Evidence for a hepatopulmonary syndrome

“…In two patients this produced severe hypoxemia. They also had clinical symptoms of hypoxia and would, according to current clinical practice in most centers, not have been accepted for liver transplantation (12). An important observation was that the VAIQ distribution improved in all six patients after transplantation with reduced log QSD and, practically, the disappearance of shunt and low VNQ.…”

Elevated exhaled nitric oxide in patients with hepatopulmonary syndrome

“…Twelve healthy volunteers, six patients with cirrhosis and three patients with cirrhosis and severe hypoxia were studied. All the cirrhotic patients were awaiting orthotopic liver transplantation, selection criteria have been reported in full previously [10]. The liver biopsies showed evidence of chronic active hepatitis (n=2), cryptogenic cirrhosis (n=5), primary biliary cirrhosis (n=1) and primary sclerosing cholangitis (n=1).…”

A prospective study on the effect of recipient nutritional status on outcome in liver transplantation

“…All patients had an OLT procedure using venovenous portal system bypass employing duct-to-duct anastomosis over a T-tube, except in patients with sclerosing cholangitis. The recipient procedure has been described elsewhere [6,18,291. The hepatic allografts were harvested by the Birmingham team according to a standard protocol.…”