Orthotopic liver transplantation for fulminant and subacute hepatic failure

Fulminant and subacute hepatitis are conditions characterized by rapid liver failure, which can lead to death in 80 to more than 95% of the cases with medical supportive care only. The etiology can be viral, drug-, or other chemical-induced, metabolic, etc. Orthotopic liver transplantation emerged during the 1980s as a powerful means for dealing with these diseases. The existence of this therapeutic modality has brought about major changes in the diagnosis, patient selection, treatment, and outlook for fulminant/subacute liver failure. The authors present the results of orthotopic liver transplantation for the treatment of 47 cases of acute/subacute hepatic insufficiency at the University of Pittsburgh between March 1980 and July 1987. The results of this series demonstrate that liver transplantation is the most effective means for treating this condition

Preservation of the retrohepatic vena cava during recipient hepatectomy for orthotopic transplantation of the liver.

A modified final phase of recipient hepatectomy in orthotopic hepatic transplantation is presented. It involves preservation of the retrohepatic vena cava "in toto" to decrease the risk of injury to the adrenal gland and assure better control of the adrenal vein, as well as the forming of the caval cuffs, for the subsequent implantation of the donor liver

Cholangiocarcinoma in sclerosing cholangitis. The role of liver transplantation

Our experience with patients who underwent orthotopic liver transplantation for sclerosing cholangitis at the University of Pittsburgh Health Center between March 1980 and March 1988 is reported here. Ten patients had an associated cholangiocarcinoma. Six of these patients died of recurrent, disseminated cancer, usually before one year. One patient died of sepsis, while three are alive and apparently free of tumor four months to almost two years later. Pre-operative identification of a possible cholangiocarcinoma and complete resection are of crucial importance. Adjuvant therapy, especially pre-transplant radiation with a prophylactic purpose is still being evaluated

Surgical technique of orthotopic liver transplantation

Athough significant strides have been made in the surgical technique of orthotopic liver transplantation, numerous problems and nuisances are still encountered. Further surgical refinements will certainly evolve. The development of better preservation techniques, the use of intraoperative flowmeters, and the availability of new technologies, such as an artificial liver, should impact and advance the techniques of liver transplantation significantly and improve the overall results even further