The experimental work of Welsh and Cannon in the mid-1950s, followed by its initial clinical application to liver transplantation in humans by Dr. Starzl in the 1960s, set the foundation for the development of liver transplantation. Refinements in surgical and anesthetic techniques, the application of venovenous bypass, the ability to correct coagulopathies, better understanding of the natural history of liver diseases, a significant improvement in intensive care medicine, effective viral, fungal, and bacterial prophylaxis, and the development of different immuno-suppressive therapies led to significant advances in the field of liver transplantation. In 1983 the National Institutes of Health (NIH) Consensus Development Conference determined that liver transplantation was no longer an experimental modality, but a valid therapy for selected acute and chronic liver diseases. The better outcomes of liver transplantation coupled with the NIH Consensus Development Conference Statement, led to the proliferation of liver transplantation programs throughout the United States.
For the past 2 years the number of deceased liver transplantations performed in the United States has been relatively static at around 4,500. On the other hand, the number of patients on the liver transplantation waiting list has increased 15-fold, and the number of waiting list deaths has increased 5-fold over the period from 1988 to 1997. As of January 2004, there are > 17,581 patients listed on the United Network of Organ Sharing (UNOS) liver waiting list in the United States. In 2003,1,501 patients died while waiting for a liver transplantation. This significant discrepancy between organ availability and need for transplantation has led liver transplantation surgeons to adopt surgical alternatives with the goal of expanding the donor pool. These alternatives include (1) split liver transplantation from deceased donors, (2) liver transplantation from nonheart-beating donors and (3) living donor liver transplantation (LDLT). In the following section, the surgical aspects of these transplantation modalities are discussed.
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