Observations on preservation, bile drainage and rejection in 64 human orthotopic liver allografts

The combined Cambridge/King's College Hospital series of 64 orthotopic liver grafts' experience dates back to 1968. Many patients were referred for liver grafting late in the course of their diseases and were operated on when they were too ill or died before suitable livers could be found. Complications of biliary drainage were the most frequent causes of death. In the past two years we have acquired experience of a method of liver preservation which permits up to 8 hours of safe storage without any complicated machines and we have been able to transport 22 livers by air and road from other institutions to our own unit. This has enlarged the pool of potential donors and therefore reduced the average waiting time for a liver transplant. A new method of biliary drainage has been employed in 24 patients using the vascularised gall bladder as a conduit between the donor and recipient common ducts. This has resulted in a marked reduction in early postoperative complications of biliary fistula and obstructed bile drainage. Now that survival has improved, it has become clear that uncontrollable rejection of the allografted liver in man is much less severe than that experienced with kidney transplants. The results of liver grafting in our unit during the past year are better than those obtained with kidneys from cadaver donors.