Skip to main content
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1988 Jul 1;139(1):21–28.

Liver transplantation: current concepts.

W J Wall 1
PMCID: PMC1267982  PMID: 3289710

Abstract

In this decade liver transplantation has been established as the preferred treatment for children and adults with irreversible end-stage liver disease. Biliary atresia in children and nonalcoholic cirrhosis in adults are the most common indications for the procedure. Transplantation currently plays only a minor role in the treatment of hepatic malignant disease. Blood group compatibility between donor and recipient is preferred, but histocompatibility matching (tissue typing) currently has no significant role in the selection of recipients. Approximately 70% of recipients survive for 1 year, and these patients have an excellent prospect of long-term survival. The emerging evidence indicates that the quality of life and rehabilitation of most liver recipients are good. The current success of liver transplantation can be attributed to critical selection of recipients, modern anesthetic and surgical techniques, improved perioperative care, accurate diagnosis of rejection and superior immunosuppression with cyclosporine.

Full text

PDF
21

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alagille D. Extrahepatic biliary atresia. Hepatology. 1984 Jan-Feb;4(1 Suppl):7S–10S. doi: 10.1002/hep.1840040704. [DOI] [PubMed] [Google Scholar]
  2. Borel J. F., Feurer C., Gubler H. U., Stähelin H. Biological effects of cyclosporin A: a new antilymphocytic agent. Agents Actions. 1976 Jul;6(4):468–475. doi: 10.1007/BF01973261. [DOI] [PubMed] [Google Scholar]
  3. Brems J. J., Hiatt J. R., Ramming K. P., Quinones-Baldrich W. J., Busuttil R. W. Fulminant hepatic failure: the role of liver transplantation as primary therapy. Am J Surg. 1987 Jul;154(1):137–141. doi: 10.1016/0002-9610(87)90304-7. [DOI] [PubMed] [Google Scholar]
  4. Calne R. Y. Liver transplantation for liver cancer. World J Surg. 1982 Jan;6(1):76–80. doi: 10.1007/BF01656376. [DOI] [PubMed] [Google Scholar]
  5. Calne R. Y., Rolles K., White D. J., Thiru S., Evans D. B., McMaster P., Dunn D. C., Craddock G. N., Henderson R. G., Aziz S. Cyclosporin A initially as the only immunosuppressant in 34 recipients of cadaveric organs: 32 kidneys, 2 pancreases, and 2 livers. Lancet. 1979 Nov 17;2(8151):1033–1036. doi: 10.1016/s0140-6736(79)92440-1. [DOI] [PubMed] [Google Scholar]
  6. Calne R. Y. Transplantation of the liver. Ann Surg. 1978 Aug;188(2):129–138. doi: 10.1097/00000658-197808000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Calne R. Y., White D. J., Evans D. B., Thiru S., Henderson R. G., Hamilton D. V., Rolles K., McMaster P., Duffy T. J., MacDougall B. R. Cyclosporin A in cadaveric organ transplantation. Br Med J (Clin Res Ed) 1981 Mar 21;282(6268):934–936. doi: 10.1136/bmj.282.6268.934. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Calne R. Y., White D. J., Thiru S., Evans D. B., McMaster P., Dunn D. C., Craddock G. N., Pentlow B. D., Rolles K. Cyclosporin A in patients receiving renal allografts from cadaver donors. Lancet. 1978 Dec 23;2(8104-5):1323–1327. doi: 10.1016/s0140-6736(78)91970-0. [DOI] [PubMed] [Google Scholar]
  9. Calne R. Y., Williams R. Orthotopic liver transplantation: the first 60 patients. Br Med J. 1977 Feb 19;1(6059):471–476. doi: 10.1136/bmj.1.6059.471. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Calne R. Y., Williams R., Rolles K. Liver transplantation in the adult. World J Surg. 1986 Jun;10(3):422–431. doi: 10.1007/BF01655302. [DOI] [PubMed] [Google Scholar]
  11. Christensen E., Schlichting P., Fauerholdt L., Gluud C., Andersen P. K., Juhl E., Poulsen H., Tygstrup N. Prognostic value of Child-Turcotte criteria in medically treated cirrhosis. Hepatology. 1984 May-Jun;4(3):430–435. doi: 10.1002/hep.1840040313. [DOI] [PubMed] [Google Scholar]
  12. Cook G. C., Mulligan R., Sherlock S. Controlled prospective trial of corticosteroid therapy in active chronic hepatitis. Q J Med. 1971 Apr;40(158):159–185. doi: 10.1093/oxfordjournals.qjmed.a067264. [DOI] [PubMed] [Google Scholar]
  13. Cuervas-Mons V., Julio Martinez A., Dekker A., Starzl T. E., Van Thiel D. H. Adult liver transplantation: an analysis of the early causes of death in 40 consecutive cases. Hepatology. 1986 May-Jun;6(3):495–501. doi: 10.1002/hep.1840060329. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Demetris A. J., Jaffe R., Sheahan D. G., Burnham J., Spero J., Iwatsuki S., Van Theil D. H., Starzl T. E. Recurrent hepatitis B in liver allograft recipients. Differentiation between viral hepatitis B and rejection. Am J Pathol. 1986 Oct;125(1):161–172. [PMC free article] [PubMed] [Google Scholar]
  15. DuBois R. S., Rodgerson D. O., Martineau G., Shroter G., Giles G., Lilly J., Halgrimson C. G., Starzl T. E., Sternlieb I., Scheinberg I. H. Orthotopic liver transplantation for Wilson's disease. Lancet. 1971 Mar 13;1(7698):505–508. doi: 10.1016/s0140-6736(71)91121-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Esquivel C. O., Koneru B., Karrer F., Todo S., Iwatsuki S., Gordon R. D., Makowka L., Marsh W. J., Jr, Starzl T. E. Liver transplantation before 1 year of age. J Pediatr. 1987 Apr;110(4):545–548. doi: 10.1016/s0022-3476(87)80545-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Fisch R. O., McCabe E. R., Doeden D., Koep L. J., Kohlhoff J. G., Silverman A., Starzl T. E. Homotransplantation of the liver in a patient with hepatoma and hereditary tyrosinemia. J Pediatr. 1978 Oct;93(4):592–596. doi: 10.1016/s0022-3476(78)80893-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Gordon R. D., Iwatsuki S., Esquivel C. O., Tzakis A., Todo S., Starzl T. E. Liver transplantation across ABO blood groups. Surgery. 1986 Aug;100(2):342–348. [PubMed] [Google Scholar]
  19. Grant D., Stiller C., Duff J., McKenzie N., Wall W., Keown P., Ghent C., Kostuk W., Kutt J., Chin J. Experience of a Canadian multi-organ transplant service. CMAJ. 1986 Aug 1;135(3):197–203. [PMC free article] [PubMed] [Google Scholar]
  20. Grant D., Wall W., Duff J., Stiller C., Ghent C., Keown P. Adverse effects of cyclosporine therapy following liver transplantation. Transplant Proc. 1987 Aug;19(4):3463–3465. [PubMed] [Google Scholar]
  21. Grant D., Wall W., Girvan D., Ghent C., Duff J., Jenner M. Orthotopic liver transplantation in children. J Pediatr Surg. 1987 Aug;22(8):705–709. doi: 10.1016/s0022-3468(87)80609-7. [DOI] [PubMed] [Google Scholar]
  22. Iwatsuki S., Gordon R. D., Shaw B. W., Jr, Starzl T. E. Role of liver transplantation in cancer therapy. Ann Surg. 1985 Oct;202(4):401–407. doi: 10.1097/00000658-198510000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Iwatsuki S., Popovtzer M. M., Corman J. L., Ishikawa M., Putnam C. W., Katz F. H., Starzl T. E. Recovery from "hepatorenal syndrome" after orthotopic liver transplantation. N Engl J Med. 1973 Nov 29;289(22):1155–1159. doi: 10.1056/NEJM197311292892201. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Iwatsuki S., Starzl T. E., Gordon R. D., Esquivel C. O., Todo S., Tzakis A. G., Makowka L., Marsh J. W., Jr, Miller C. M. Late mortality and morbidity after liver transplantation. Transplant Proc. 1987 Feb;19(1 Pt 3):2373–2377. [PMC free article] [PubMed] [Google Scholar]
  25. Kahan B. D., Flechner S. M., Lorber M. I., Jensen C., Golden D., Van Buren C. T. Complications of cyclosporin therapy. World J Surg. 1986 Jun;10(3):348–360. doi: 10.1007/BF01655294. [DOI] [PubMed] [Google Scholar]
  26. Kaplan M. M., Alling D. W., Zimmerman H. J., Wolfe H. J., Sepersky R. A., Hirsch G. S., Elta G. H., Glick K. A., Eagen K. A. A prospective trial of colchicine for primary biliary cirrhosis. N Engl J Med. 1986 Dec 4;315(23):1448–1454. doi: 10.1056/NEJM198612043152304. [DOI] [PubMed] [Google Scholar]
  27. Kaufman S. S., Wood R. P., Shaw B. W., Jr, Markin R. S., Rosenthal P., Gridelli B., Vanderhoof J. A. Orthotopic liver transplantation for type I Crigler-Najjar syndrome. Hepatology. 1986 Nov-Dec;6(6):1259–1262. doi: 10.1002/hep.1840060606. [DOI] [PubMed] [Google Scholar]
  28. Lauchart W., Müller R., Pichlmayr R. Immunoprophylaxis of hepatitis B virus reinfection in recipients of human liver allografts. Transplant Proc. 1987 Feb;19(1 Pt 3):2387–2389. [PubMed] [Google Scholar]
  29. Lerut J., Gordon R. D., Iwatsuki S., Esquivel C. O., Todo S., Tzakis A., Starzl T. E. Biliary tract complications in human orthotopic liver transplantation. Transplantation. 1987 Jan;43(1):47–51. doi: 10.1097/00007890-198701000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Liver grafting. Transplantation. 1983 Feb;35(2):109–111. doi: 10.1097/00007890-198302000-00001. [DOI] [PubMed] [Google Scholar]
  31. Malatack J. J., Finegold D. N., Iwatsuki S., Shaw B. W., Jr, Gartner J. C., Zitelli B. J., Roe T., Starzl T. E. Liver transplantation for type I glycogen storage disease. Lancet. 1983 May 14;1(8333):1073–1075. doi: 10.1016/s0140-6736(83)91910-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. McCarthy P. M., van Heerden J. A., Adson M. A., Schafer L. W., Wiesner R. H. The Budd-Chiari syndrome. Medical and surgical management of 30 patients. Arch Surg. 1985 Jun;120(6):657–662. doi: 10.1001/archsurg.1985.01390300007001. [DOI] [PubMed] [Google Scholar]
  33. Moore S. B., Wiesner R. H., Perkins J. D., Nagorney D. M., Sterioff S., Krom R. A. A positive lymphocyte cross-match and major histocompatibility complex mismatching do not predict early rejection of liver transplants in patients treated with cyclosporine. Transplant Proc. 1987 Feb;19(1 Pt 3):2390–2391. [PubMed] [Google Scholar]
  34. Neuberger J., Portmann B., Calne R., Williams R. Recurrence of autoimmune chronic active hepatitis following orthotopic liver grafting. Transplantation. 1984 Apr;37(4):363–365. doi: 10.1097/00007890-198404000-00009. [DOI] [PubMed] [Google Scholar]
  35. Ohi R., Hanamatsu M., Mochizuki I., Chiba T., Kasai M. Progress in the treatment of biliary atresia. World J Surg. 1985 Apr;9(2):285–293. doi: 10.1007/BF01656322. [DOI] [PubMed] [Google Scholar]
  36. Organ transplantation. Liver. Transplant Proc. 1985 Feb;17(1 Pt 1):250–301. [PubMed] [Google Scholar]
  37. Perkins J. D., Sterioff S., Wiesner R. H., Offord K. P., Rakela J., Dickson E. R., Krom R. A. Conversion from standard cyclosporine to low-dose cyclosporine and azathioprine therapy as treatment for cyclosporine-related complications in liver transplant patients. Transplant Proc. 1987 Feb;19(1 Pt 3):2434–2436. [PubMed] [Google Scholar]
  38. Peto R., Pike M. C., Armitage P., Breslow N. E., Cox D. R., Howard S. V., Mantel N., McPherson K., Peto J., Smith P. G. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. Br J Cancer. 1977 Jan;35(1):1–39. doi: 10.1038/bjc.1977.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Pitt H. A., Thompson H. H., Tompkins R. K., Longmire W. P., Jr Primary sclerosing cholangitis: results of an aggressive surgical approach. Ann Surg. 1982 Sep;196(3):259–268. doi: 10.1097/00000658-198209000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Roll J., Boyer J. L., Barry D., Klatskin G. The prognostic importance of clinical and histologic features in asymptomatic and symptomatic primary biliary cirrhosis. N Engl J Med. 1983 Jan 6;308(1):1–7. doi: 10.1056/NEJM198301063080101. [DOI] [PubMed] [Google Scholar]
  41. STARZL T. E., MARCHIORO T. L., VONKAULLA K. N., HERMANN G., BRITTAIN R. S., WADDELL W. R. HOMOTRANSPLANTATION OF THE LIVER IN HUMANS. Surg Gynecol Obstet. 1963 Dec;117:659–676. [PMC free article] [PubMed] [Google Scholar]
  42. Schade R. R. The changing indications for liver transplantation. Transplant Proc. 1987 Aug;19(4 Suppl 3):2–6. [PubMed] [Google Scholar]
  43. Shapiro J. M., Smith H., Schaffner F. Serum bilirubin: a prognostic factor in primary biliary cirrhosis. Gut. 1979 Feb;20(2):137–140. doi: 10.1136/gut.20.2.137. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Starzl T. E., Ishikawa M., Putnam C. W., Porter K. A., Picache R., Husberg B. S., Halgrimson C. G., Schroter G. Progress in and deterrents to orthotopic liver transplantation, with special reference to survival, resistance to hyperacute rejection, and biliary duct reconstruction. Transplant Proc. 1974 Dec;6(4 Suppl 1):129–139. [PMC free article] [PubMed] [Google Scholar]
  45. Starzl T. E., Iwatsuki S., Shaw B. W., Jr, Van Thiel D. H., Gartner J. C., Zitelli B. J., Malatack J. J., Schade R. R. Analysis of liver transplantation. Hepatology. 1984 Jan-Feb;4(1 Suppl):47S–49S. doi: 10.1002/hep.1840040714. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Starzl T. E., Iwatsuki S., Van Thiel D. H., Gartner J. C., Zitelli B. J., Malatack J. J., Schade R. R., Shaw B. W., Jr, Hakala T. R., Rosenthal J. T. Evolution of liver transplantation. Hepatology. 1982 Sep-Oct;2(5):614–636. doi: 10.1002/hep.1840020516. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Starzl T. E., Klintmalm G. B., Porter K. A., Iwatsuki S., Schröter G. P. Liver transplantation with use of cyclosporin a and prednisone. N Engl J Med. 1981 Jul 30;305(5):266–269. doi: 10.1056/NEJM198107303050507. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Starzl T. E., Koep L. J., Halgrimson C. G., Hood J., Schroter G. P., Porter K. A., Weil R., 3rd Fifteen years of clinical liver transplantation. Gastroenterology. 1979 Aug;77(2):375–388. [PMC free article] [PubMed] [Google Scholar]
  49. Starzl T. E., Koep L. J., Schröter G. P., Hood J., Halgrimson C. G., Porter K. A., Weil R., 3rd The quality of life after liver transplantation. Transplant Proc. 1979 Mar;11(1):252–256. [PMC free article] [PubMed] [Google Scholar]
  50. Starzl T. E., Koep L., Porter K. A., Schroter G. P., Weil R., 3rd, Hartley R. B., Halgrimson C. G. Decline in survival after liver transplantation. Arch Surg. 1980 Jul;115(7):815–819. doi: 10.1001/archsurg.1980.01380070009002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Starzl T. E., Porter K. A., Putnam C. W., Schroter G. P., Halgrimson C. G., Weil R., 3rd, Hoelscher M., Reid H. A. Orthotopic liver transplantation in ninety-three patients. Surg Gynecol Obstet. 1976 Apr;142(4):487–505. [PMC free article] [PubMed] [Google Scholar]
  52. Starzl T. E., Todo S., Gordon R., Makowa L., Tzakis A., Iwatsuki S., Marsh W., Esquivel C., Van Thiel D. Liver transplantation in older patients. N Engl J Med. 1987 Feb 19;316(8):484–485. doi: 10.1056/NEJM198702193160814. [DOI] [PubMed] [Google Scholar]
  53. Starzl T. E., Zitelli B. J., Shaw B. W., Jr, Iwatsuki S., Gartner J. C., Gordon R. D., Malatuck J. J., Fox I. J., Urbach A. H., Van Thiel D. H. Changing concepts: liver replacement for hereditary tyrosinemia and hepatoma. J Pediatr. 1985 Apr;106(4):604–606. doi: 10.1016/s0022-3476(85)80081-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Van Thiel D. H., Schade R. R., Gavaler J. S., Shaw B. W., Jr, Iwatsuki S., Starzl T. E. Medical aspects of liver transplantation. Hepatology. 1984 Jan-Feb;4(1 Suppl):79S–83S. doi: 10.1002/hep.1840040721. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Van Thiel D. H., Tarter R., Gavaler J. S., Potanko W. M., Schade R. R. Liver transplantation in adults. An analysis of costs and benefits at the University of Pittsburgh. Gastroenterology. 1986 Jan;90(1):211–216. [PubMed] [Google Scholar]
  56. Wall W. J., Duff J. H., Ghent C. N., Stiller C. R., Keown P. A., Kutt J. L. Liver transplantation: the initial experience of a Canadian centre. Can J Surg. 1985 May;28(3):286–289. [PubMed] [Google Scholar]
  57. Wall W. J., Grant D. R., Duff J. H., Kutt J. L., Ghent C. N., Bloch M. S. Liver transplantation without venous bypass. Transplantation. 1987 Jan;43(1):56–61. doi: 10.1097/00007890-198701000-00013. [DOI] [PubMed] [Google Scholar]
  58. Wall W. J., Stiller C. R., Wright F. F., Feindel C. M., Duff J. H., Wallace A. C. Experimental and clinical liver transplantation. Transplant Proc. 1982 Dec;14(4):724–729. [PubMed] [Google Scholar]
  59. Wallwork J., Williams R., Calne R. Y. Transplantation of liver, heart, and lungs for primary biliary cirrhosis and primary pulmonary hypertension. Lancet. 1987 Jul 25;2(8552):182–185. doi: 10.1016/s0140-6736(87)90765-3. [DOI] [PubMed] [Google Scholar]
  60. Williams R., Calne R. Y., Rolles K., Polson R. J. Current results with orthotopic liver grafting in Cambridge/King's College Hospital series. Br Med J (Clin Res Ed) 1985 Jan 5;290(6461):49–52. doi: 10.1136/bmj.290.6461.49. [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Williams R., Gimson A. E. An assessment of orthotopic liver transplantation in acute liver failure. Hepatology. 1984 Jan-Feb;4(1 Suppl):22S–24S. doi: 10.1002/hep.1840040708. [DOI] [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES