Ken A. Porter

Orthotopic homotransplantation of the human liver.

Orthotopic Homotransplantation of the Human Liver Thomas Starzl;Carl Groth;Lawrence Brettschneider;Israel Penn;Vincent Fulginiti;John Moon;Herve Blanchard;Alfred Martin;Ken Porter; Annals of Surgery

Infections in Recipients of Liver Homografts

Abstract Seventeen patients received liver homografts between 1963 and May, 1968. The eight treated before July, 1967, died within 34 days; seven had progressive infections with gram-negative bacilli, Candida albicans and cytomegalovirus. The infections were similar to but more fulminating than those after renal homotransplantation. In nine later cases, there was more discriminating donor selection, improved immunosuppression, and better organ preservation. In the first five of these nine patients, all infants, lobar hepatic gangrene apparently secondary to delayed right hepatic arterial thrombosis developed. Two died within a few days, two and three and a half months after transplantation. The three who did not die immediately subsequently had multiple bacteremias, fungemias and cytomegalovirus pulmonary infections. One of these children is alive twelve months after transplantation; the others died after four and a half and six months. In contrast, the last four patients, in whom septic liver infarctions...

The Role of Organ Transplantation in Pediatrics

Experience has been recounted with 22 patients treated with renal homotransplantation at or before the age of 18 years. Eighteen of the 22 patients are still alive from 3½ months to three years after operation. Twelve are alive at least 21 months postoperatively; eight of the 12 are two to three years. The unique technical, medical and sociologic problems encountered in treating patients of this age group are described. Biopsies of eight of the homografts from 21 to 26 months after operation revealed that only one of the kidneys was normal. The others showed narrowing of the interlobular arteries by fibrous intimal thickening and interstitial infiltration by large lymphoid cells. In two of the homografts there was also thickening of the glomerular capillary basement membranes, giving an appearance resembling diffuse membranous glomerulonephritis. Juxtaglomerular hyperplasia was present in six of the eight homografts. n nProgress in the field of liver transplantation is also cited. The principal encouraging developments have been in animal experimentation. Although long-term survival in human subjects has not yet been achieved, dogs with orthotopic liver transplantation have been living in good health for as long as 20 months. Advances have also been made bearing upon auxiliary liver transplantation, an operation which does not involve removal of the patients own liver. Although preservation of the patients liver would seem to be advantageous for several reasons, there are also serious and fundamental disadvantages to this approach which may limit its usefulness.