Progress in and deterrents to orthotopic liver transplantation, with special reference to survival, resistance to hyperacute rejection, and biliary duct reconstruction

An account is given of 82 consecutive orthotopic liver transplantations carried out in Colorado. Eighteen patients have lived for 1 year postoperatively, and the longest survival is almost 5 years. Much of the high failure rate is attributable to the technical difficulty of the operation and especially to complications of the biliary duct reconstruction. A strategy for biliary duct reconstruction is advanced that is designed to place the liver as far outside the mainstream gastrointestinal tract as possible, to avoid unnecessary sacrifice of biliary duct tissue and to facilitate reoperation at the slightest sign of a technical complication. An experience is cited in 6 patients who received 6 homografts and 1 chimpanzee heterograft in which livers were transplanted against preferred anti red cell isoagglutinins or leukocyte cytotoxins. Hyperacute rejection did not occur, nor was there convincing evidence of antibody mediated rejection in any case. The conclusion is that the liver may be more resistant to hyperacute rejection than is the kidney.