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History of Liver Transplantation Liver transplantation has developed tremendously over the past 40 years. When Dr. Starzl, the father of liver transplantation, performed his first liver transplant in 1963, the long term rate for survival was slim and few surgeons were willing to undertake such an overwhelming task. Since the first transplant, advances in surgical techniques, patient selection and management, and immunosuppression have resulted in improved long term survival rates after transplantation. Dr. Starzl performed the first liver transplant on a three year old patient in 1963. Although the transplant was unsuccessful, the information learned from that experience led to improvements in immunosuppression and transplant procedures. Four years later in 1967, Dr. Starzl performed the first successful liver transplant on an 18 month old child, who survived for 400 days before she eventually died. After this successful liver transplant, the number of transplants performed continued to increase each year. The development of cyclosporine in 1963 and 1964 was integral in the long term survival of liver transplant patients. Of the first 12 liver transplants performed by Dr. Starzl and treated with cyclosporine and prednisone (a steroid) in the first eight months of 1980, 11 lived longer than one year and seven survived at least 12 years. During a conference on June 20-23, 1983, the National Institutes of Health (NIH) reviewed 296 liver transplant cases from four countries. Based on the case results, the NIH conference participants decided that liver transplantation is a valid therapy for end stage liver disease (ESLD) patient. This decision by the NIH helped health insurance companies and medical professionals to change their opinions of transplantation as risky and experimental to a life saving treatment. The 1980s was a decade in which new immunosuppressant drugs were used after transplantation to help increase graft and patient survival by treating acute and chronic rejection more effectively. The goal of immunosuppression is to abrogate the recipient’s immune response to the new liver. Cyclosporine was considered revolutionary to liver transplantation. It was developed in the 1960s and approved by the FDA for human use in 1983. Cyclosporine, when combined with steroids, helped to improve patient survival rates. Another immunosuppressant drug, tacrolimus (FK506, Prograf) was first introduced in 1989. The introduction of this drug has vastly aided in the treatment of organ rejection. With the help of immunosuppressant drugs, one year survival rates have increased from 35% in the 1960s and 1970s to the current rate of 85-90%. Unfortunately, the supply of livers from non-living donors is far shorter than the number of potential recipients, a reality that has spurred the development of living donor transplantation.
Transplant Surgery Office
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