Which advances have improved survival following orthotopic liver transplantation (OLT)?

Updated: Apr 19, 2019
  • Author: Vanessa A Olcese, MD, PhD; Chief Editor: Ron Shapiro, MD  more...
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In 1963, Starzl and colleagues performed the first liver transplantation procedure. This patient, along with the next 4, died of bleeding complications. To define the operative technique, many practice operations were performed on animals, but the surgical team was unprepared for the technical difficulties of liver explantation in the presence of advanced portal hypertension.

Starzl et al performed the first successful human liver transplantation in 1967. Initial survival rates were poor, with only 24% of adults and 33% of children surviving the first year after liver transplantation through the 1970s.

Many factors have contributed to improvements in the mortality rates since that time, including improved operative techniques and experience, improved preoperative and postoperative care, and other factors beyond the scope of this article. Aspects addressed herein are the risk for perioperative death as a result of massive blood loss and coincidental complications, analyses of preoperative conditions, review of the assessment of coagulopathy, and risk factors for bleeding.

Specific advances, including autologous transfusion with cell saver–washed erythrocytes, venovenous bypass, and argon-beam coagulation, have contributed to liver transplantation success. The procedure can now be performed in as little as 4 hours, often with no or minimal transfusion.

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