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The “dream” of liver transplantation did not exist until 1955, when C. Stuart Welch of Albany, New York, published his article, “A note on transplantation of the whole liver in dogs.”1

The idea was to insert an auxiliary canine liver in the recipient animal. For an entire decade after that, many attempted to fulfill that dream, working on experimental animal models, mainly dogs.2–7 Parallel to the efforts to develop a successful technique, a serious look at the major problem of rejection was made by Starzl.8,9

Thomas E. Starzl (surrounded by a dedicated team), in Denver, Colorado, devoted his career to making this dream come true. By March 1, 1963, encouraged by the fact that some dogs survived up to 100 days after a liver transplant, Starzl attempted the first human orthotopic liver transplantation (OLTx). Unfortunately, the child died 5 hours after the operation. On May 4, 1963, the second human OLTx was performed. This time, the patient, a 48-year-old, survived 22 days before dying of pulmonary embolism.10 Despite these complications, Dr. Starzl was never discouraged from pursuing his dream.

A major technical modification made then was to perform the procedure entirely through an abdominal incision rather than a thoracoabdominal approach, and a concomitant splenectomy was deemed unnecessary.10

On October 30, 1967, with 14 cases of human liver transplantation to his name, Dr. Starzl presented his results to the American audience on television.10 This broadcast raised public awareness and interest in both organ donation and liver transplantation. By March 1972, Dr. Starzl had performed 36 cases, with 10 of the patients living for more than 1 year and 1 surviving for 3½ years after transplantation.

This marked the birth of the technique of OLTx. The efficacy of the technique was confirmed between 1962 and 1981 when more than 170 liver transplants were performed in Colorado, with a 1-year survival rate of almost 30%. So, the success story was far from being achieved. Challenges included the following:

  • The scarcity of human donors

  • Organ preservation and control of postperfusion injury

  • The technical difficulty of native hepatectomy in patients with severe portal hypertension and intraabdominal adhesions

  • Intraoperative hemodynamic, metabolic, hemostatic, and homeostatic instability

  • The unavailability of safe immunosuppressive drugs contributed to loss of organs and lives

  • Prevention and control of infection after transplantation

Before the end of the 1970s, major advances materialized in this field:

  • The use of the Euro-Collins solution for organ preservation, enabling preservation of the liver for up to 8 hours11,12

  • The use of “donor” vascular grafts (arterial and venous) for vascular construction13

  • The introduction of cyclosporin as a powerful immunosuppressive drug by Sir Roy Calne14


The decade from 1980 to 1989 witnessed a huge increase in the success of ...

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