The transplantation of gastrointestinal organs

Over a period of 33 years, it has become possible to successfully transplant individual intra-abdominal viscera or combinations of these organs. The consequences have been, first, new information about the metabolic interrelations that the visceral organs have in disease or health; second, the addition of several procedures to the treatment armamentarium of gastrointestinal diseases; and third, a more profound understanding of the means by which all whole organ grafts are accepted. © 1993

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Transplantation in children

Kidney transplantation in very young children, less than 2 years of age, has usually failed, mainly because of difficulties maintaining these patients on hemodialysis long enough to permit retransplantation after loss of the original graft. Liver replacement in the very young child has been associated with a higher frequency of vascular and biliary obstruction than in the older child, due to the small size of these structures. Such accidents have contributed to unsatisfactory results with biliary atresia. Transplantation of kidney or liver into older children has been more successful than transplantation of these organs into adults. Related or cadaveric kidney transplantation in the child has been followed by at least a 60 per cent patient survival for 6 to 13 years and a very acceptable quality of life. Liver replacement for diseases other than biliary atresia has been followed by a 56 per cent 1 year survival rate, and two children have survived for more than 5 years

Evidence that host size determines liver size: Studies in dogs receiving orthotopic liver transplants

Orthotopic liver transplantation was performed in two groups of dogs; Group I animals consisted of large dogs that served as recipients of livers obtained from smaller dogs while Group II animals consisted of dogs that received liver from donor dogs of nearly the same size. The small‐for‐size livers transplanted into the Group I dogs rapidly increased in size over the course of 2 weeks until they achieved a size equal to that originally present in the larger recipient dogs. In contrast, the livers transplanted into dogs of the same size as the donors underwent some degree of atrophy. In both groups of animals, plasma levels of insulin and glucagon and hepatic (graft) activities of thymidine kinase and ornithine decarboxylase were followed serially. The only difference between the two groups of animals for these measures was that the ornithine decarboxylase activity rose to a greater degree in the liver that underwent graft enlargement. These data suggest that recipient size determines, at least in part, liver graft size once it is transplanted. These data also suggest that of the parameters followed, only ornithine decarboxylase activity parallels the finding of growth of the transplanted liver. Copyright © 1987 American Association for the Study of Liver Disease

World's longest surviving liver-pancreas recipient

In July 1988, the liver and pancreas of a cadaveric donor were transplanted separately into a man with type 1 diabetes with end-stage chronic hepatitis B virus. Two features of the operation may help explain the patient's current status as the longest-lived liver-pancreas recipient. One was enteric drainage of pancreatic exocrine secretions. The other was delivery of the pancreas venous effluent to the host portal system and then directly to the hepatic allograft. © 2007 AASLD

Clinical xenotransplantation

Abstract: Two baboon liver xenografts transplanted to patients with B virus hepatitis supported life for 70 and 26 days but did not function optimally despite minimum or no histopathologic findings of overt humoral or cellular rejection in serial biopsies. However, there was evidence of complement activation in both cases, which in retrospect was thought to explain the unsatisfactory outcome. Strategies to deal with this problem are discussed. © 1994 Munksgaar