Hepatic Transplantation

The hepatic transplantation , or clerk's office of the liver , is an surgical operation consisting in replacing a sick Foie by a healthy liver, taken on a Donneur.

The liver being the only body having the capacity to regenerate itself, it is possible to carry out a hepatic transplantation starting from a Greffon taken in an alive donor, pertaining to the family close to the Receveur. Most frequently, the graft comes from a donor declared in a state of encephalic death.

To avoid the Rejection, it is necessary to have a Compatibilité optimal HLA and the treatment Immunosuppresseur is essential. For certain fulminant hepatitises, the urgency can bring not to take account of compatibility HLA.

History

; the Sixties

March 1st 1963: the first hepatic transplantation carried out by Pr Thomas Starzl at a 3 year old patient reaches of a Atrésie bile Ducts having led to a hepatic Insuffisance. The deceased child of a hemorrhage at the time of the operation which takes place with Denver, Colorado.

1963: four other unfruitful interventions are carried out in adults

1969: with Leuwen in Belgium, is realized by Pr Kestens and Pr Otte the first transplantation hepatic in Europe, at a patient reached of a Hépatite B which will die of a pneumopathy one month later.

; the Seventies

March 17th 1971: transplantation successful in a 17 month old child in Leuwen.

; the Eighties

The arrival of Ciclosporine has, powerful treatment Immunosuppresseur, will allow the rise of hepatic transplantation.

Many doctors come to improve with Pittsburgh, become the center pionner.

February 1984: success of a hepatic Clerc's Office at a patient reached of a Cirrhosis due to a Hepatitis B realized by professors Kestens, Otte and of Hemptinne.

August 1984: the first hepatic transplantation in the child with a liver reduced to Leuwen

January 1988: hepatic transplantations in the adult with graft resulting from an alive donor

; the Nineties

July 1993: Hepatic transplantations in the child with graft resulting from an alive donor

Indications

fulminant Hepatitis
chronic Cholestase: primitive biliary cirrhosis, cholangite sclerosing, atresy of the bile ducts
Cirrhosis: of alcoholic origin (weaning must be higher than 6 months), viral (Hépatite B, Hépatite C), auto-immune…
metabolic Hépatopathie: Hémochromatose, Disease of Wilson
primitive Cancers of the liver: according to certain criteria resulting from consensus, like the criteria of Milan
Others: Syndrome of Budd-Chiari

Counter-indications

not separated alcoholic Cirrhosis
hepatic Tumors apart from the criteria favorable to transplantation
Heart failure or respiratory
congenital or acquired immunizing Deficit (HIV)
cerebral Atrophy

Technique

August 1st

Complications

Complications related to the intervention and causal pathology

Malfunction of the graft, hemorrhages and thrombosis of the hepatic artery.

Repeat of causal pathology on the graft: alcoholism not separated, hepatitis B or C

Rejections and complications related to the immunosuppressor treatment

Rejection hyperaigu, acute rejection or chronic rejection.

Infections bacterial, viral and parasitic, néoplasies related to the immunosuppression

Random links: