Current Policies in Hepatic Transplantation: Candidacy of Patients With Alcoholic Liver Disease or Preformed Antidonor Antibodies and a Reappraisal of Biliary Duct Reconstruction*

Eighty-two patients have been treated by orthotopic hepatic transplantation in Denver since 1963. Eighteen and nine patients have lived for 1 year and 2 years posttransplantation, respectively. Thirteen recipients are still alive from 3 weeks to almost 5 years postoperatively. Current policy has been reexamined in 3 areas in light of this experience. First, only the occasional potential recipient with alcoholic liver disease, free of infectious or other complications, is an acceptable candidate for this procedure. Second, the presence in the recipient's serum of preformed anti-red cell or lymphocytotoxic antibodies to his donor is a relative, but not an absolute, contraindication to hepatic transplantation, since the liver appears to be more resistant to hyperacute rejection than the kidney. Finally, a 6-point program has been outlined for establishing and evaluating bile drainage, in order to prevent or remedy both the technical and bacteriologic complications associated with faulty biliary reconstruction.