Orthotopic and heterotopic liver transplantation : circulatory and hemostatic effects of experimental long-term graft preservation

Almost a quarter of a century ago, Starzl accomplished the first successful liver transplantation in man1 Since then, hepatic allograft survival steadily increased as a result of progress in patient care, immunosuppressive treatment, surgical techniques, and organ preservation. So, orthotopic liver transplantation (OLT) has become an effective therapy for end-stage liver disease with one-year patient survival ranging from 70% to 90% at various centers2 -5 Still, many patients with profound hemostatic disturbances or concomitant cardiovascular disease may not be able to tolerate such a major operation. One aspect of the advances in surgical techniques is the evolution of the auxiliary heterotopic liver transplantation (HL1). This is an alternative to the orthotopic procedure and has some attractive potential advantages over OLT. Another progress in liver preservation is the extension of the duration of graft preservation. As happened in kidney transplantation, this may change liver transplantation from an emergency procedure into a semielective one

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