[Developmental and current status of clinical liver transplantation]

Liver transplantation is gradually beginning to move from the experimental to the clinical stage. Of the approx. 340 human "transplantation" which have been carried out worldwide, approx. 250 were performed by the transplantation teams in Denver and Cambridge. They were performed orthotopically. The detailed analysis of the indications by Calne ( n = 81) and Starzl (n = 153) is supplemented by analysis of the course of a total of 223 cases. Individual cases, such as a child with a liver transplant which is functioning for 9 1/2 years, show that liver transplantation is possible. Statistically, however, liver transplantation still involves a big question mark. Nevertheless, the Denver team has announced a 1 year survival quota of almost 50%. In the statistics on the causes of death, technical complications are clearly on the decline. The biliodigestive anastomosis constituted a "locus minoris resistentae", recently, however, the complication rate has been lowered considerably by the use of a Roux-Y-loop bypass and an intermediate gallbladder conduit. Infectious complications - bacterial, fungal and viral - caused or at least promoted by immunosuppression are a main problem. The special immunologic situation of the liver in transplantation has as yet not been clarified either experimentally or clinically. Unequivocal evidence of graft rejection is often difficult, because infectious and drug-induced liver intoxications can produce similar symptoms.