[The selection and preparation of recipients for orthotopic liver transplantation]

Transplantation of the liver, which was performed for the first time in world practice in 1963, employs today the experience in more than 10,000 liver transplantations and solves successfully such scientific-practical problems of this large field as: further improvement in the schemes for selection and preparation of the recipients, improvement of diagnostics and differential diagnostics, and treatment. Since there is neither much experience nor good information on the subject in our country, not all clinics for internal diseases are sufficiently informed. In view of that, there is a growing need in preparation from the psychological standpoint rather than in the selection of patients. The inefficacy of the traditional therapy of chronic hepatic insufficiency created the premises for the search for new methods in the period of complex preparation with the use of modern pathogenetically substantiated technology. This led to wide introduction of auxiliary methods of treatment into the clinic, such as plasmapheresis and hemoperfusion through cryopreserved hepatocytes which, we think, produce good results in preoperative management of the patients. The principal problem of our preoperative management by extracorporeal methods is temporary compensation of the nonfunctioning kidney during the critical period so that its regeneration would attain the minimal volume necessary for maintenance of vital processes. And in this temporary period of "the stage of relative remission" or favorable period transplantation of the liver must be carried out. Extracorporeal methods of blood cleansing in potential recipients with malignant neoplasms in the liver showed quite the reverse, we do not recommend this method for these patients without jaundice.