Organ transplantation update, part I: liver, intestine, and pancreas.

On March 1, 1963, an iconoclastic surgeon named Dr Thomas Starzl performed the first human liver transplants in Colorado. The first 3 patients were a child with biliary atresia, a 48-year-old man with alcoholic cirrhosis and hepatocellular carcinoma, and a 67-year-old man with advanced cholangiocarcinoma. These 3 patients all died within a month of the procedure. Four more patients then received liver transplants in Denver, Boston, and Paris with equally poor results. For the next 3 years, there was a self-imposed moratorium on liver transplantation. During this period, surgical and medical techniques were refined, with improved preservation techniques and the addition of antithymocyte globulin to the immunosuppressant regimen of prednisone and azathioprine. In July 1967, the liver program at Colorado under Dr Starzl was reopened and the first successful liver transplant was performed, in a patient who survived for approximately 1 year before dying from recurrent hepatocellular carcinoma. Despite the early success in the late 1960s and early 1970s, the mortality rate after liver transplant remained high due to the procedure’s technical complexities as well as the lack of medications to adequately counteract rejection of the transplanted organ. The four decades since the pioneering work of Dr Starzl have realized tremendous advancements in the field of liver transplantation. Thousands of lives have been saved after walking through the initial