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Liver transplantation — State of the art

Lebertransplantation — State of the Art

  • Main Topics: Transplantation Surgery
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Abstract

Background: It is 30 years since the first human liver transplantation (LT) took place in Denver, Colorado. Many advances have taken place since that date. This paper examines the current state of LT.

Methods: The present indications and results of LT are reviewed, organ supply, organ preservation and technical innovations are discussed.

Results: LT is now widely accepted as the only curative treatment for end stage liver disease. Indications are continuing to expand with increasing application in fulminant hepatic failure and inborn errors of metabolism. Results have improved steadily over the years with 80% one-year patient survival now being a realistic target. An adequate supply of donor organs will without doubt become an increasing problem in the coming years. Surgical innovation has seen the introduction of reduced size liver grafts for children, split liver grafts to allow the use of a single liver for 2 patients and even the use of living related liver grafts in selected cases.

Conclusions: Many challenges still exist in the fields of immunosuppression and organ preservation but steady improvement and refinement of our techniques sill result in a continuing improvement in the coming years in terms of both patient and graft survival.

Zusammenfassung

Grundlagen: Es ist 30 Jahre her, seit die erste menschliche Lebertransplantation (LT) in Denver, Colorado, stattgefunden hat. Seitdem hat man viele Fortschritte gemacht. Dieser Bericht beschäftigt sich mit dem gegenwärtigen Stand der LT.

Methodik: Die gegenwärtigen Indikationen und Resultate der LT werden beschrieben und die Verfügbarkeit von Spenderorganen, Organkonservierung und neue Techniken werden diskutiert.

Ergebnisse: Die LT wird heute als die einzige erfolgreiche Behandlung von Leberversagen im Endstadium angesehen. Die Indikationen zur LT werden fortlaufend erweitert, speziell bei fulminantem Leberzerfall und angeborenen Stoffwechselerkrankungen. Die Ergebnisse nach LT haben sich ständig verbessert, und die 1-Jahres-Patientenüberlebenszeit von über 80% ist ein realistisches Ziel. Die Verfügbarkeit von Spenderorganen wird ohne Zweifel in den kommenden Jahren ein größeres Problem werden. Chirurgische Fortschritte haben reduzierte LT für Kinder möglich gemacht. Mit einer geteilten Leber können 2 Patienten versorgt werden, und in speziellen Fällen sind sogar Transplantationen zwischen Verwandten mit Organen von lebenden Spendern möglich.

Schlußfolgerungen: Auf dem Gebiet der Immunosuppression und Organkonservierung werden noch viele Herausforderungen gestellt, aber die ständige Verbesserung der Methoden und die Entwicklung neuer Techniken werden in den kommenden Jahren zu höheren Überlebensraten sowohl für den Patienten als auch für das Organ führen.

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Authors and Affiliations

  1. Department of Surgery, Addenbrooke’s Hospital, Hills Rd., CB2 2QQ, Cambridge, United Kingdom

    N. V. Jamieson M.A., M.D., F.R.C.S.

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  1. N. V. Jamieson M.A., M.D., F.R.C.S.
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Jamieson, N.V. Liver transplantation — State of the art. Acta Chir Austriaca 26, 19–22 (1994). https://doi.org/10.1007/BF02619721

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  • DOI: https://doi.org/10.1007/BF02619721

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