Book contents
- Frontmatter
- Contents
- List of contributors
- Acknowledgments
- Preface
- Part I General issues
- Part II Head and neck
- Part III Thorax
- Part IV Abdomen
- Part V Urology
- Part VI Oncology
- Part VII Transplantation
- 64 Renal failure and transplantation
- 65 Liver transplantation
- 66 Intestinal and multivisceral transplantation
- 67 Heart and lung transplantation
- Part VIII Trauma
- Part IX Miscellaneous
- Index
- Plate section
- References
65 - Liver transplantation
from Part VII - Transplantation
Published online by Cambridge University Press: 08 January 2010
- Frontmatter
- Contents
- List of contributors
- Acknowledgments
- Preface
- Part I General issues
- Part II Head and neck
- Part III Thorax
- Part IV Abdomen
- Part V Urology
- Part VI Oncology
- Part VII Transplantation
- 64 Renal failure and transplantation
- 65 Liver transplantation
- 66 Intestinal and multivisceral transplantation
- 67 Heart and lung transplantation
- Part VIII Trauma
- Part IX Miscellaneous
- Index
- Plate section
- References
Summary
Historical aspects
Over the past 40 years, orthotopic liver transplantation (OLT) has evolved from an experimental procedure to a routine treatment of end-stage liver failure in children. The first attempt at pediatric liver transplantation by Thomas Starzl in 1963 was not successful but 4 years later he reported the first survivor. These early liver transplants were in high-risk recipients and hemorrhage, coagulopathy, and poor graft function resulted in significant intraoperative and early postoperative mortality. Prednisolone and azathioprine were the primary immunosuppressive drugs but some regimens included combinations of cyclophosphamide, anti-lymphocyte globulin, splenectomy, total body irradiation, and thymectomy. Despite advances in surgical techniques, 1-year survival after liver transplantation remained poor and by 1978 was only 30%.
The introduction of the immunosuppressant, cyclosporin, into clinical practice in 1979 transformed the outcome after OLT. Cyclosporin acts by blocking lymphocyte production of interleukin-2 and other cytokines thereby reducing the incidence and severity of acute cellular rejection. The combination of cyclosporin and corticosteroids resulted in a marked increase in graft and patient survival and reduced the need for long-term use of high dose steroids with their attendant side effects. The National Institute of Health consensus conference in 1983 concluded that liver transplantation for end-stage liver disease deserved broad application as a therapeutic option rather than an experimental procedure.
The development of newer immunosuppressive drugs, refinements in operative techniques, improved organ preservation and donor management and advances in anesthetic and intensive care have contributed further to improvements in recipient survival.
- Type
- Chapter
- Information
- Pediatric Surgery and UrologyLong-Term Outcomes, pp. 858 - 883Publisher: Cambridge University PressPrint publication year: 2006
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