To be a service, a new surgical procedure must be within the capability of more than the occasional surgeon. In addition, the indications for its use should be clear, and the results should be good enough to justify the effort and expense. In this communication, we will indicate that orthotopic liver transplantation has met all three of these criteria.
Methods
Two hundred and ninety-six patients were treated from March, 1963 through April, 1983. Until the end of 1979, "conventional" immunosuppression was used with azathioprine and prednisone to which antilymphocytic globulin was usually added (1, 2). In 16 patients treated in 1971 and 1972, cyclophosphamide was substituted for azathioprine. From early 1980 onward, immunosuppression was with cyclosporine and steroids. The surgical and medical techniques have been described elsewhere (1,2).
The results were analyzed before and after the introduction of cyclosporine-steroid therapy. In the post-1980 era, we studied a greatly expanded volume of cases, the use of veno-venous bypasses with and without heparin, and the systematic training of younger surgeons whose objective could be to set up new centers. In all of the case material, the influence of original disease upon the results also was examined.
Results
SURVIVAL WITH CONVENTIONAL IMMUNOSUPPRESSION (1963-1979) From 1963 to the end of 1979,170 consecutive patients were treated; which is an average case load of less than 12 per year. Fifty-six (32.9%) recipients lived for at least 1 year, and 32 (18.8%) are still alive with follow-up of 3% to 13% years. Six of the residual group are more than