Orthotopic Autotransplantation and Allotransplantation of the Liver

Stuart, Fiona; Torres, E; Hester, William; Dammin, Gustave J.; Moore, Francis D.

doi:10.1097/00000658-196703000-00001

Cited by 41 publications

(14 citation statements)

References 6 publications

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Section: Discussionmentioning

confidence: 93%

“…Under the latter conditions, the rate of liver abscess formation in the early postoperative period was relatively lower both in our experience 20 and in that of Moore and associates 11 and Stuart and associates. 24 Moreover, none of the more than 25 dogs followed in our laboratories for 4 to 44 months after orthotopic homotransplantation developed a late liver abscess.Until more information becomes available, it seems most reasonable to consider that hepatic necrosis from a variety of causes can initiate the chain of events which was observed in each of the presently reported cases. The pathologic evidence was that the infarctions came first.…”

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confidence: 93%

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

Starzl¹,

Groth²,

Brettschneider³

et al. 1968

Transplantation

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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 ...

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Section: Discussionmentioning

confidence: 93%

mentioning

confidence: 93%

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

Starzl¹,

Groth²,

Brettschneider³

et al. 1968

Transplantation

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“…6 Liver Transplan-Calne et al CALUMAL (1961, 1965, McBride et al (1962), and Stuart et al (1967). Most dogs died from rejection of the liver within a week of transplantation.…”

Section: Histological Findingsmentioning

confidence: 99%

“…There are not enough data to reach any conclusions on the behaviour of livers transplanted in man without immunosuppression. In patients treated with azathioprine, corticosteroids, and antilymphocyte globulin, cellular infiltra- (Calne et al, 1966;Stuart et al, 1967). The mai lymphatic sac is opened in dissecting the aorta for both hepatic and renal transplants, and any possible immunosuppressive effect would presumably have been shown in the renal transplants as well as the hepatic transplants.…”

Section: Histological Findingsmentioning

confidence: 99%

Prolonged survival of liver transplants in the pig

Calne¹,

White²,

Yoffa³

et al. 1968

Transplantation

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Our preliminary experience with orthotopic liver transplantation in the pig has been reported (Calne et al., 1967). Out of 19 animals operated on 13 survived the procedure and six lived for a week or more. Focal necrosis of liver cells and round-cell infiltration in the portal triads of these six transplants was thought to represent evidence of a weak rejection process. One pig died after seven months from intestinal obstruction with minimal evidence of liver damage. Three pigs developed severe gastrointestinal haemorrhage due to mucosa erosions of the stomach and duodenum. We were impressed with the relatively mild rejection occurring in liver transplants in the pig, and it is the purpose of this paper to present our further experience in this field. We have added vagotomy and gastroenterostomy in an attempt to prevent the gastrointestinal haemorrhage and have related the rejection of liver transplants in the pig to transplants of kidneys and skin in this animal. Materials and MethodsOrthotopic Liver Transplantation, Vagotomy, and Gastroduodenostomy (36 Experiments)In the course of our experiments details of technique have been modified and the present technique, which has been used in the last 20 transplants, has had an operative mortality of *

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“…Recently the effects of lymph stasis have gained a special importance at organ transplantations. The lymphatics of the transplanted organs are ligated and it was shown that some disturbances in the function of the transplant are due to the interruption of its lymphatic drainage [4,8). Lymph production in the liver is very copious: normally one third to one half at the lymph transported by the thoracic duct is produced in this organ 17).…”

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confidence: 99%

The effect of the occlusion of liver lymphatics on hepatic blood flow

1976

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In the dog after the ligation of the thoracic duct and of the lymphatics of liver hilum hepatic blood flow decreased in 2hrs by 30.6 per cent. The flow reduction is due to the increase of arterial and venous inflow resistances and of the prehepatic splanchnic arteriolar resistance. The vascular reaction in lymph stasis differs insofar from the reaction seen during biliary duct obstruction that in the latter condition hepatic artery flow is increased. A preexistent lymph stasis does not abolish the increase in the hepatic artery flow produced by raised biliary tract pressure. The differences between the flow reactions observed in bile stasis and in lymph stasis are explained by the accumulation in the latter condition of a protein rich fluid in the liver tissue.

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Orthotopic Autotransplantation and Allotransplantation of the Liver

Cited by 41 publications

References 6 publications

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

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

Prolonged survival of liver transplants in the pig

The effect of the occlusion of liver lymphatics on hepatic blood flow

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