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Harrison's Principles of Internal Medicine, 18e
| Part 14. Disorders of the Gastrointestinal System > Section 2. Liver and Biliary Tract Disease > |
Chapter 310. Liver Transplantation
Sections: Liver Transplantation: Introduction, Indications, Contraindications, Technical Considerations, Postoperative Course and Management, Outcome, Further Readings.
Topics Discussed: liver transplantation; solid-organ transplantation.
Excerpt:"Liver transplantation—the replacement of the native, diseased liver by a normal organ (allograft)—has matured from an experimental procedure reserved for desperately ill patients to an accepted, lifesaving operation applied more optimally in the natural history of end-stage liver disease. The preferred and technically most advanced approach is orthotopic transplantation, in which the native organ is removed and the donor organ is inserted in the same anatomic location. Pioneered in the 1960s by Thomas Starzl at the University of Colorado and, later, at the University of Pittsburgh and by Roy Calne in Cambridge, England, liver transplantation is now performed routinely worldwide. Success measured as 1-year survival has improved from  30% in the 1970s to 90% today. These improved prospects for prolonged survival, dating back to the early 1980s, resulted from refinements in operative technique, improvements in organ procurement and preservation, advances in immunosuppressive therapy, and, perhaps most influentially, more enlightened patient selection and timing. Despite the perioperative morbidity and mortality, the technical and management challenges of the procedure, and its costs, liver transplantation..."
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