Liver transplantation.

From March 1963 through June 1976, 111 patients received orthotopic liver homografts. Forty-two of the recipients had congenital biliary atresia. Other common diagnoses were chronic aggressive hepatitis, Laennec's cirrhosis, and primary hepatic malignancy. There were also other assorted, less common diagnoses. Thirty-one of the 111 patients (28%) lived at least one year and 15 are still alive with follow-ups of 2 1/2 to 8 1/2 years. Seven of the patients lived for more than five years, and 6 of these 7 are still alive. In 1975 and 1976, clinical-pathologic correlations on all these patients were carried out with Professor K.A. Porter of London. The most common causes for failure were technical misadventures, including biliary tract problems, vascular thromboses, and the use of ischemically damaged livers. Rejection was less of a problem than had been realized. In view of these findings, improvements in intraoperative and postoperative management were made with particular reference to biliary tract drainage and to the use of microvascular techniques. Treatment of a new series of 30 patients was begun in July 1976, and completed in December 1977. After 6 to 22 months, 15 of the 30 most recently treated patients are alive, all living outside the hospital. Thus, the outlook after transplantation appears to have greatly improved, and a one-year survival rate of 50% is projected.