Liver transplantation

Human liver transplantation, which was first performed in man in Denver 15 years ago, has finally come of age in the past 2 years. The 1 year survival has improved from 28 per cent to 50 per cent in the recent Denver Second Series. Past experience has shown that long-term prognosis can usually be determined based on the 1 year assessment. Patients who are fit with a well functioning liver are likely to remain well. This applied to the 45 per cent of the 1 year survivors in the First Denver Series, who are still alive today at between 2 5/6 and 8 5/6 years. It has however, been a much more frequent finding in the Second Series, which suggests that a significant number of patients should be long-term survivors in the future. Improved survival has been attributed to a number of factors including a better understanding of the rejection and infection problems in immunosuppressed liver recipients. Postoperative hepatic dysfunction is no longer as easily ascribed to rejection, and an aggressive diagnostic approach has helped to prevent over-immunosuppression. Furthermore, new approaches to the biliary anastomosis, and a better understanding of the blood supply of the human bile duct, is currently preventing many of the earlier catastrophes related to this, the Achilles heel of liver tranplantation

Liver Resection for Hepatic Adenoma

Between 1970 and 1978, eight hepatic adenomas were resected. Four of the eight patients took oral contraceptive pills before the hepatic adenoma was identified; one patient was male. Four patients had evidence of bleeding at the time of presentation. The original histologic diagnosis in the first five patients was malignant hepatoma. There has been no known recurrence of tumor and all patients are well. The use of oral contraceptives in these patients has been prohibited. Formal anatomic resection is recommended for hepatic adenoma when this procedure can be done without mortality or serious morbidity; however, in the future, less drastic treatments, such as occlusion of the hepatic arterial circulation to the tumor or discontinuation of oral contraceptives, may prove as effective as tumor resection. © 1979, American Medical Association. All rights reserved

The technique of prolonged thoracic duct drainage in transplantation

Prolonged thoracic duct drainage as an immunosuppressive adjunct was accomplished in 96 per cent of organ recipients upon whom it was attempted

Thoracic duct drainage in organ transplantation: Will it permit better immunosuppression?

It is possible that thoracic-duct drainage, a major but neglected immunosuppressive adjunct, can have an important impact on organ transplantation. If thoracic-duct drainage is started at the time of transplantation, the practicality of its use in cadaveric cases is greatly enhanced. With kidney transplantation, the penalty of not having pretreatment for the first organ is compensanted by the automatic presence of pretreatment if rejection is not controlled and retransplantation becomes necessary. The advantage of adding thoracic-duct drainage to conventional immunosuppression may greatly enhance the expectations for the transplantation of extrarenal organs, such as the liver, pancreas, heart, and lung. There is evidence that pretreatment with thoracic-duct drainage of patients with cytotoxic antibodies may permit successful renal transplantation under these otherwise essentially hopeless conditions. Exploration of the neglected but potentially valuable tool of thoracic-duct drainage seems to the authors to be highly justified in other centers

Portacaval Shunt and Hyperlipidemia

The use of a completely diverting portacaval shunt for the purpose of lowering the serum concentration of cholesterol and low-density lipoproteins is reviewed and a recommendation provided that such a shunt for hyperlipidemia should be considered for type II individuals. (Arch Surg 113:71-74, 1978). © 1978 American Medical Association. All rights reserved

Thoracic duct drainage before and after cadaveric kidney transplantation

Twenty-seven consecutive recipients of cadaveric kidneys, including five with pre-existing warm cytotoxic antibodies, were treated with thoracic duct drainage before and after transplantation. Fourteen patients who had lymph drainage for 26 to 58 days before transplantation had minor cytotoxic antibody responses after grafting, even if the antibodies had been present before therapy. Only one of the 14 recipients had any rejection during the follow-up periods of one to six months. There were two deaths. The 13 patients pretreated for 17 to 23 days exhibited stronger cytotoxic antibody responsiveness, and five of these recipients had significant rejections of which four were reversible. One of the latter 13 patients died. These clinical and immunologic studies have established the value and have defined the appropriate timing of preoperative thoracic duct drainage in kidney transplantation. They have also directed attention to the rationale and the probable value of using other immunosuppressive methods for preparatory host conditioning instead of beginning such therapy at the time of transplantation