Chapter-04 Expanding Indications for Liver Transplantation

BOOK TITLE: Recent Advances in Surgery 33

1. Silva Michael A
2. Friend Peter J
Publishing Year
Author Affiliations
1. Oxford Radcliffe NHS Trust, UK
2. University of Oxford, UK
Chapter keywords


The first liver transplant was performed by Thomas Starzl in 1963 but it was four years before there was a long-term survivor. Liver transplantation in Europe was first performed by Roy Calne in 1968. Throughout the 1970s and 1980s, liver transplantation remained the preserve of a very small group of pioneers who struggled with surgical and immunological problems leading to poor long-term results. The rapid expansion of liver transplantation, which took place during the 1980s was due to the advent of newer immunosuppression, particularly cyclosporine, which enabled lower levels of rejection to be achieved while reducing the doses of steroids needed. Later, in the 1990s, further new drugs contributed to improving results, particularly tacrolimus and mycophenolate. The efficacy of organ preservation was substantially improved with the introduction of University of Wisconsin solution at around the same time. These benefits, combined with incremental improvements in surgical, anesthetic and postoperative care resulted in a massive improvement in the outcome of liver transplantation between 1980 and 2000. Liver transplantation was formally acknowledged as an effective therapy for endstage liver disease at an NIH consensus meeting in June 1983 and was rapidly adopted by an increasing number of transplant units around the world. In recent years, 1-year and 5-year survival figures of 90% and 75% have been achieved. This success has inspired management guidelines for patients with liver disease that recommend that every patient with endstage liver disease be referred for liver transplant assessment.

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