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Review
, 13 (1), 149-52

Liver Transplantation: History, Outcomes and Perspectives

[Article in English, Portuguese]
Affiliations
Review

Liver Transplantation: History, Outcomes and Perspectives

[Article in English, Portuguese]
Roberto Ferreira Meirelles Júnior et al. Einstein (Sao Paulo).

Abstract

In 1958 Francis Moore described the orthotopic liver transplantation technique in dogs. In 1963, Starzl et al. performed the first liver transplantation. In the first five liver transplantations no patient survived more than 23 days. In 1967, stimulated by Calne who used antilymphocytic serum, Starzl began a successful series of liver transplantation. Until 1977, 200 liver transplantations were performed in the world. In that period, technical problems were overcome. Roy Calne, in 1979, used the first time cyclosporine in two patients who had undergone liver transplantation. In 1989, Starzl et al. reported a series of 1,179 consecutives patients who underwent liver transplantation and reported a survival rate between one and five years of 73% and 64%, respectively. Finally, in 1990, Starzl et al. reported successful use of tacrolimus in patents undergoing liver transplantation and who had rejection despite receiving conventional immunosuppressive treatment. Liver Transplantation Program was initiated at Hospital Israelita Albert Einstein in 1990 and so far over 1,400 transplants have been done. In 2013, 102 deceased donors liver transplantations were performed. The main indications for transplantation were hepatocellular carcinoma (38%), hepatitis C virus (33.3%) and alcohol liver cirrhosis (19.6%). Of these, 36% of patients who underwent transplantation showed biological MELD score > 30. Patient and graft survival in the first year was, 82.4% and 74.8%, respectively. A major challenge in liver transplantation field is the insufficient number of donors compared with the growing demand of transplant candidates. Thus, we emphasize that appropriated donor/receptor selection, allocation and organ preservation topics should contribute to improve the number and outcomes in liver transplantation.

Figures

Figure 1
Figure 1. Actuarial survival curve. Kaplan-Meier of patients who underwent liver transplantation at Hospital Israelita Albert Einstein (n=748) and at other liver transplantation services in São Paulo State (n=3.738) from January 2006 and December 2013
Figure 2
Figure 2. Actuarial survival curve. Kaplan-Meier of patients who received hepatic allografts at Hospital Israelita Albert Einstein (n=858) and at other liver transplantation services in São Paulo State (n=4.075) from January 2006 and December 2013
Figura 1
Figura 1. Curva de sobrevida atuarial. Kaplan-Meier de pacientes transplantados de fígado no Hospital Israelita Albert Einstein (n=748) e em outros serviços de transplante de fígado do Estado de São Paulo (n=3.738), no período de 1o de janeiro de 2006 a 31 de dezembro de 2013
Figura 2
Figura 2. Curva de sobrevida atuarial. Kaplan-Meier dos enxertos hepáticos no Hospital Israelita Albert Einstein (n=858) e em outros serviços de transplante de fígado do Estado de São Paulo (n=4.075), no período de 1o de janeiro de 2006 a 31 de dezembro de 2013

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