Transplantation of the Liver, 3e
The first edition of Transplantation of the Liver was published in 1996. At that time, the practice of liver transplantation had developed internationally and was acknowledged as the definitive treatment for virtually all types of end-stage liver disease. The first edition was designed to serve as a platform to codify what had evolved in the development of liver transplantation since 1963,
when Dr. Thomas E. Starzl performed the first clinical liver transplant. Additionally, it focused on the many advances in the field that had developed since that sentinel event.
In 2005 the second edition was published, and by that time a revolutionary change in organ allocation had been enacted by the Organ Procurement and Transplantation Network (OPTN), which had a significant impact on the practice of liver transplantation. Based on the Model for End-Stage Liver Disease (MELD) and the Pediatric Model for End-Stage Liver Disease (PELD), the new allocation system completely altered the algorithm for patient evaluation, maintenance, wait listing, and priority for transplantation. Since the implementation of these changes, there has been a dramatic shift toward organs being allocated to the sickest of recipients and to patients with hepatocellular carcinoma and other primary hepatic malignancies who were allowed to be listed because they fulfilled the approved exception criteria. As a result, this current edition thoroughly discusses these changes in indications, the benefits, and the potential risks. As editors, our ambition has always been that this textbook would be considered state of the art while concurrently keeping the format for general reference. To that end, we have completely updated all of the chapters and added new ones to reflect new knowledge and expertise.
The third edition of Transplantation of the Liver essentially follows the same format as its predecessors. The Pearls and Pitfalls sections have been expanded significantly as these summaries are intended to serve as salient words of wisdom from experienced mentors to share with their less-experienced counterparts in the field.
As in the previous editions, when recruiting new authors, we turned to individuals recognized for their expertise in a particular specialty. When possible, we strived to have different views that might apply to a specific issue or problem because, in many cases, successful approaches are often varied. Furthermore, all chapters have been updated to be relevant to our current practice. Chapter 1, on the history of liver transplantation, has been entirely reworked to illustrate the tremendous contributions of transplant pioneers for the benefit of current clinicians in the field who may not have had the opportunity to interact with them personally. We highly recommend this chapter for every reader.
Several new chapters reflect recent developments in the specialty. In “Part I: General Considerations,” we have incorporated a chapter that discusses regulatory and ethical issues in organ donation, including donation after cardiac death versus brain death. We have expanded “Part II: Patient Evaluation: Adult” with two new chapters. One chapter focuses on liver transplantation for cholangiocarcinoma, and the other examines nonalcoholic steatotic hepatitis (NASH), a diagnosis that may very well overtake hepatitis C as the most common indication for liver transplantation in many countries during the next few years. A new chapter on pulmonary hypertension and hepatopulmonary syndrome has also been included in “Part IV: Special Considerations in Patient Evaluation.”
A chapter on extended criteria donors was added to “Part V: Operation,” reflecting the ever-increasing need for donors that necessarily compels us to accept donors whom we rarely used when the first edition of this textbook was published. “Part VI: Split and Living Donor Transplantation” has been greatly expanded as a direct result of the substantial increased experience and knowledge in this field. Chapters on biliary and vascular reconstructions, small-for-size syndrome, minimally invasive living donor hepatectomy, and dual grafts for transplantation have been added. “In Part VII: Unusual Operative Problems,” a new chapter on the varied techniques of arterial reconstruction is featured.
Two new chapters can be found in “Part VIII: Postoperative Care.” The first broaches an increasingly common yet delicate challenge: the transition of pediatric patients to adulthood. This topic was not adequately addressed in prior editions and is a growing issue that puts a very special and novel demand on the transplant care team. The second new chapter concerns recurrent hepatitis C after liver transplantation, which is a significant problem today. Hopefully, with the new drugs that have recently become available, this will be primarily of historical interest by the time the fourth edition is contemplated. The complex and difficult complication of graft-versus-host disease was given a separate chapter in “ Part X: Immunology of Liver Transplantation.” Along with the maturation of liver transplantation, large numbers of patients are living several decades after transplantation. Thus, we thought it prudent to address the effect of long-term toxicity of immunosuppressive therapy with a new chapter in “Part XI: Immunosuppression.” Finally, in “Part XIII: Future Developments in Liver Transplantation,” there are two new chapters that look to the future. The first chapter discusses stem cell and liver regeneration, and the second focuses on extracorporeal perfusion to resuscitate marginal grafts.
It has been extremely gratifying personally and professionally to watch our field develop and flourish before our eyes. We both feel very fortunate and humbled to have the opportunity to safeguard the mantle created by the father of liver transplantation, Dr. Starzl, as leaders of our own programs. We appreciate being able to pass this mantle along through our textbook and our respective fellowship programs. We dedicate this work to Dr. Starzl and his contemporary pioneers Drs. Roy Calne, Rudolph Pichlmayr, and Henri Bismuth. May this text serve as an ode to their vision and the legacy that they have created worldwide.
Ronald W. Busuttil, MD, PhD
Göran B.G. Klintmalm, MD, PhD
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