Richard Weil

Fifteen Years of Clinical Liver Transplantation

Liver transplantation in humans was first attempted more than 15 yr ago. The 1-yr survival has slowly improved until it has now reached about 50%. In our experience, 46 patients have lived for at least 1 yr, with the longest survival being 9 yr. The high acute mortality in early trials was due in many cases to technical and management errors and to the use of damaged organs. With elimination of such factors, survival increased. Further improvements will depend upon better immunosuppression. Orthotopic liver transplantation (liver replacement) is the preferred operation in most cases, but placement of an extra liver (auxiliary transplantation) may have a role under special circumstances.

Transplantation in Children

Kidney transplantation in very young children, less than 2xa0years of age, has usually failed, mainly because of difficulties in maintaining these patients on hemodialysis long enough to permit retransplantation after loss of the original graft. Transplantation of kidney or liver into older children has been more successful than transplantation of these organs into adults.

Neuraminidase Treated Homologous IgG and Immune Deposit Renal Disease in Inbred Rats

Summary Immune deposit renal disease followed intravenous or intraperitoneal injections of neuraminidase treated homologous IgG or neuraminidase alone. No alterations were associated with several groups of controls. This preliminary study suggests that one mechanism by which microorganisms may be involved in the development of immune renal disease is by chemical alteration of immunoglobulin.

The Pretreatment Principle in Renal Transplantation as Illustrated by Thoracic Duct Drainage

In spite of all that has been achieved, renal transplantation still provides a flawed and unpredictable service. In the average American center in the decade of the seventies, less than half the recipients of first cadaver kidneys had graft function by the end of the first postoperative year. One reason may be neglect of what has been called the “forgotten pretreatment principle.” It is that subject which is addressed here, with particular emphasis on thoracic duct drainage (TDD).

Pediatric kidney transplantation for cystinosis.

In an experience of more than 700 kidney transplants, three recipients are known to have had congenital cystinosis. A cadaver kidney transplant in a 10 yr old child with nephropathic cystinosis functioned well for 7 1/2 yr before it was rejected and the graft was free of recurrent cystinosis after that interval. This prolongation of life was associated with marked accumulation of cystine in the patients thyroid gland, presenting as a mass in the neck. If additional longevity is achieved in this patient, abnormal intracellular cystine accumulation may be expected in other host tissues. Retransplantation was carried out with the father as donor, accepting the possibility of increased cystine levels in the retransplant. This patients age of 18 yr identifies him as one of the longest known survivors of infantile nephropathic cystinosis.

Acute and chronic effects of chemically induced unilateral renal disease in rats.

Summary Chemically induced unilateral renal disease was associated with a high incidence of proteinuria, diuresis, a morphological spectrum ranging from perinephritis to acute tubular or cortical necrosis, and unilateral or bilateral glomerular fibrinogen deposition during the first 2 wk after induction. Later, a decrease in proteinuria and return to normal urine output was not infrequently followed by recurrent proteinuria, hypergammaglobulinemia, morphological alterations, and deposition of IgG and β1C on the glomerular basement membranes and mesangium of the contra-lateral kidney and the treated kidney. Inter-capillary deposition of fibrinogen in association with IgG and β1C was occasionally observed in one or both kidneys. The morphologic, immunohistologic, serologic, and chemical findings suggest that this model may be useful for further defining the course and prognosis of unilateral renal disease produced by vascular insufficiency.

Portacaval Shunt for Type II Hyperlipidemia

Amelioration of Type 2 hyperlipidemia by completely diverting portacaval shunt was first reported in 1973 (Starzl et al). Since then, 5 additional patients have been similarly treated by us and others have been treated elsewhere. The compiled first cases have been published (Starzl, Putnam and Koep 1978) and, doubtless more will be added by Stein in his review later today. My remarks today will be confined to a brief description of 6 patients treated at the University of Colorado from one month to 6 1/2 years ago.