LIVER-TRANSPLANTATION

Human liver transplantation, which was first performed in man in Denver 15 years ago, has finally come of age in the past 2 years. The 1 year survival has improved from 28 per cent to 50 per cent in the recent Denver Second Series. Past experience has shown that long-term prognosis can usually be determined based on the 1 year assessment. Patients who are fit with a well functioning liver are likely to remain well. This applied to the 45 per cent of the 1 year survivors in the First Denver Series, who are still alive today at between 2 5/6 and 8 5/6 years. It has however, been a much more frequent finding in the Second Series, which suggests that a significant number of patients should be long-term survivors in the future. Improved survival has been attributed to a number of factors including a better understanding of the rejection and infection problems in immunosuppressed liver recipients. Postoperative hepatic dysfunction is no longer as easily ascribed to rejection, and an aggressive diagnostic approach has helped to prevent over-immunosuppression. Furthermore, new approaches to the biliary anastomosis, and a better understanding of the blood supply of the human bile duct, is currently preventing many of the earlier catastrophes related to this, the Achilles heel of liver tranplantation.