History of Pediatric Liver Transplantation

The first orthotopic liver transplant was attempted in 1963 by Thomas E. Starzl and associates, on a 3-year old boy with biliary atresia &. The patient died during the transplant because of a fatal hemorrhage and uncontrollable coagulopathy. After that, 6 more liver transplants were carried out on adult recipients in Denver &, Boston &, and Paris &. All failed and the procedure seemed too difficult to allow clinical application. Moreover, the experience of the first 7 cases suggested that the immunosuppressive therapy and the preservation methods available at that time were too primitive to permit success.
Four years later, with new techniques of organ preservation & and better immunosuppressive protocols &, the first successful liver replacement was obtained in a 1 ½-year old child with hepatoma &. This baby was the first long survivor, and died of recurrent cancer after 400 days. For the next 12 years, liver transplantation was performed on a regular basis by Thomas E. Starzl, at the University of Colorado &, and by Sir Roy Calne, at the Cambridge University &. In these series the 1-year mortality rate was always above 50%, with about 10% to 20% of the patients living more than 10 years. All were treated with azathioprine, or anti-cancer agent, cyclophosphamide, prednisone, and polyclonal antilymphocyte globulin.
The discouraging results ended when cyclosporine was introduced for the clinical use in 1979 &, and used in combination with other immunosuppressive drugs &. One-year patient survival rates of at least 70% were achieved, and several new liver transplant programs were established worldwide. In 1983 the National Institute of Health Development Conference concluded that orthotopic liver transplantation was a therapeutic rather than experimental procedure.
Continued advancements in immunosuppression, surgical techniques, preoperative and postoperative management evolved in a dramatic increase in the frequency and success of liver transplantation. Pediatric patients undergoing liver replacement today can expect survival rates approaching 90% &.