Early Liver Transplantation in Europe

Abstract

We were interested to read the letter of Umberto Maggi (1) drawing attention to the description of Jean Demirleau’s first attempt on February 5, 1964 at transplanting a liver in man, as reported at the French “Academie de Chirugie.” Although in no way decrying the courage and initiative of Demirleau and his colleagues—and our experience showed just how much was required of those involved in the early transplantation programs—it is the obtaining of worthwhile survival that is the justification for introducing a new surgical technique particularly one as major as liver transplantation was in every respect. Demirleau’s patient survived only 3 hr as did the first few cases done by Starzl. However, Starzl did succeed in obtaining better survival after modifying his immunosuppression regimen in the second series of clinical transplants, which he started in 1965. Our first case in what became Cambridge/King’s College Hospital joint program was a lady of 46 years, who was operated on February 5, 1968 in Cambridge with Dr. Francis Moore as first assistant. The patient survived 11 weeks, dying of thrombosis of the hepatic artery. The third case in the series was operated on at King’s on September 23, 1968 (OL3) and survived 4.5 months in good health. The indication was a primary hepatocellular carcinoma arising in a noncirrhotic liver with a 19 cm maximum tumor diameter, worth noting in relation to ongoing arguments about limits on tumor size in selecting such cases for transplantation. The patient was discharged from hospital on the 17th postoperative day and was able to go back to work. He finally died at 4.5 months after developing chronic rejection. Another early case who did extraordinarily well (OL9) and who gave us much encouragement in continuing the program was transplanted in February 1969 at Newmarket Hospital. She had a large hepatocellular carcinoma, arising like our first patient at King’s in a noncirrhotic liver. She lived for 5 years and 2 months in excellent health, finally dying without tumor recurrence from a cholangitis-septicemia. The first demonstration of the remarkable potential of transplantation in reversing the major functional derangements of liver decompensation was shown in an inpatient (OL10) with advanced cirrhosis who had developed a severe chronic encephalopathy after a portal-caval anastomosis. Transplanted in March 1969, by the second week after transplantation, his electroencephalograph, which had been grossly abnormal, showed a return of the normal α components and mental function was remarkably improved. For the record, our longest surviving patient (OL61) is alive and well after having been transplanted on March 2, 1977. He recently completed a 140-mile bicycle ride over hills in the West Country. Roy Calne 1 Roger Williams2 1 Department of Surgery University of Cambridge Cambridge, UK 2 The Foundation for Liver Research The Institute of Hepatology London, UK