Liver transplantation in man. I. Observations on technique and organization in five cases

In view of the extreme sensitivity of the human liver to ischaemic damage, the organization of clinical transplantation is of necessity complicated. From our preliminary experience of five human liver allografts we feel that active collaboration between hospitals is essential in order to practise human liver transplantation. It is unnecessary and undesirable to interfere in any way with potential liver donors. Nevertheless, the nature of the surgical technique requires that the liver is cooled within 15 minutes of death if satisfactory function is to result in the grafted organ.This report describes technical difficulties that were encountered which can limit successful liver transplantation. The first patient was in severe liver failure and had an accessory liver graft in the splenic fossa after splenectomy. This liver suffered irreversible ischaemic damage, which led to an uncontrollable haemorrhagic state with exsanguination that resulted in death the day after operation. The second patient, a 10-month-old infant with biliary atresia and liver failure, died from cardiac arrest shortly after the operation.The remaining three transplants developed good initial function. One patient survived 11 weeks, and one has returned to work.