Monday, September 24, 2012

NEJM: Liver Transplantation — A Vision Realized

Liver Transplantation — A Vision Realized

Jules L. Dienstag, M.D., and A. Benedict Cosimi, M.D.
September 19, 2012 (10.1056/NEJMp1210159)
The history of medicine is that what was inconceivable yesterday and barely achievable today often becomes routine tomorrow.1
Little more than a generation ago, treatment options for end-stage liver disease were few and of limited durable utility. Little could be done to stem the decline of affected patients, who would ultimately go on to have liver failure and portal hypertension — variceal bleeding, intractable ascites, peritonitis, jaundice, hepatic encephalopathy, and coagulopathy — culminating in multisystem failure.
All that changed in 1983, when successes in experimental liver transplantation justified the procedure's generalization as standard treatment. In a tribute to the pioneers who shepherded liver transplantation from barely imagined concept to fully implemented reality, the 2012 Lasker–DeBakey Clinical Medical Research Award honors Thomas Starzl of the University of Pittsburgh and Roy Calne of Cambridge University. Together, these physician-scientists bridged an intellectual and technical chasm as wide and forbidding as the ocean that separated them.
The era of solid-organ transplantation was inaugurated in 1954 with a successful kidney transplantation between identical twin brothers. But while nascent approaches to immunosuppression permitted renal transplantation to flourish, early efforts at liver transplantation stagnated, despite observations in pigs and dogs suggesting that the liver might be an “immunologically privileged” organ....
Continue reading @ NEJM

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