Académie royale de Médecine de Belgique

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Résumé de Jan Lerut (Séance du 26.11.2011)

 

LIVER TRANSPLANTATION OR STARZL’S LEGACY : A LOOK BACKWARD, A LOOK FORWARD

par  J. LERUT (U.C.L.), invité.

Since the successful introduction of liver transplantation in clinical practice by Starzl in 1963 an enormous evolution has been made.

Liver transplantation is actually the mainstay of all end-stage acute and chronic liver diseases and of several metabolic non cirrhogenic liver diseases.

This paper gives an overview of the progresses that have been made during nearly half a century. Indeed, due to improved surgical and medical care as well as more refined immunosuppressive schemes, only one out of ten absolute and five relative contra-indications, put forward by the NIH Consensus conference on liver transplantation in 1983, remains valid namely a generalised sepsis in the liver recipient.

Unfortunately long-term immunosuppression is responsible for many lethal cardiovascular, infectious and tumour complications of patients harbouring a well functioning graft.

From now onwards, the attention of transplant physician should be focused on optimalizing quality of life of the successfully transplanted recipient by minimisation or even withdrawal of immunosuppressive drugs.

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