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Liver Transplantation: Down the memory lane
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“Liver, brain and heart these sovereign thrones”
(Twelfth Night, Act 1, Scene 1)
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Historically, in ancient civilizations, man had already imagined changes in the morphology, structure and function of the human body. Egyptian and Greco-Roman mythology provides us with countless examples of the metamorphoses sung by Homer and Ovid, symbolic incarnations of the “comedie humaine” with its strength, weaknesses, vices and virtues.
The liver has been the noble organ, the organ of life from time immemorial - liver in English, Leber in German, derived from the verb to live. Shakespeare a faithful interpreter of ancient traditions places the liver in first position in his famous list :
The current status of liver transplantation as a realistic treatment for acute and chronic end-stage disease has been long-awaited. Mythical literature richly describes transplantation as a cure for disease. Subsequently, in modern times, replacing a diseased organ with a healthy one from another individual, dead or alive, to enable a human to survive, can be considered to be the most stirring event in the field of medical science.
An Indian legend from the 12th century B.C. recounts the powers of Shiva, who xenotransplanted an elephant head onto a child to produce the Indian god Gaesha. In ancient China, Yue-Jen (407-310 B.C.) induced anaesthesia lasting 3 days by “the absorption of extremely strong wine, opened up the chest of two soldiers and after examining them, exchanged their hearts and transplanted them”.
The first reference to the concept of organ transplantation and replacement for therapeutic purposes appears to be to Hua-To (136 to 208 A.D.) who replaced diseased organs with healthy ones in patients under analgesia induced with a mixture of Indian hemp.
Tissue grafting began in plants and until the 12th century this technique was referred to by the word “grief”, derived from the Greek word for stylet, the tool used to perform the operation. Although attempts were made to transplant every type of organ in animals, very rapidly the kidney was adopted as the experimental model because of its bilateral nature and the large calibre of its vessels with a well isolated pedicle.
Liver transplantation was first attempted in dogs by Welch in Albany in 1955 and Cannon in California in 1956. The first liver transplant in humans was performed on March 1, 1963 by Starzl in Denver. The three-year-old child with biliary atresia, in a disastrous physiological condition, received the liver from another child who had died from a brain tumour.
The recipient survived for five hours after the transplantation, succumbing to the complications of coagulation and haemostasis encountered during the operation. The second liver transplant in man was performed on May 5, 1963, was more successful, although the patient died on the 22nd postoperative day from pulmonary embolism but with a normal liver. The first long-term survival was achieved in 1967 by Starzl. Continuing progress in the 1960's and 1970's was very slow and one year patient survival was only 35 %.
The 1980's was a decade in which new immunosuppressive therapies after liver transplantation helped to increase graft and patient survival by treating acute and chronic rejection more effectively. One-year survival for liver transplantation in Europe rose progressively from 47 % (1968-1988) to 67 % (1988-1996). A further advance was the improvement of liver preservation by the introduction of University of Wisconsin Solution (Viaspan) in 1987 extending periods of cold storage in Collins solution by two to three fold.
Jaboulay performed the first renal transplant in man, transplanting the left kidney of a pig, into the left elbow of a woman suffering from nephritic syndrome. Like other subsequent attempts the graft failed rapidly because of vascular thrombosis. Not until 1954, was it shown that a denervated kidney could function normally when reimplanted in the same person from whom it has been taken.
In 1936, the first human cadaveric renal transplant performed by Voronoy in Russia, survived four days and due to genetic incompatibility between the donor and the recipient, homologous transplantation seemed doomed to failure. Renal transplantation between monozygotic twins confirmed the necessity of genetic identity and led to a realisation of the need for immunosuppression in prolonging graft survival.
Source: The Internet Journal of Pharmacology
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