Chirurgia del Fegato a Firenze!

Dal 1° Marzo 2023, Chirurgia del Fegato sarà all'Università di Firenze
AOUC Azienda Ospedaliero-Universitaria Careggi - Largo Brambilla, 3 - 50134 Firenze

Primo xenotrapianto di fegato al mondo

Thomas Starzl esegue a Pittsburgh il primo xenotrapianto di fegato al mondo, impiantando un fegato di babbuino in un paziente di  35 anni portatore di insufficienza epatica terminale da epatite B e dell’HIV.

Il paziente sopravvive 70 giorni e muore per sepsi secondaria a complicanze dell’anastomosi biliare.

La referenza bibliografica per questo evento è:

T. E Starzl, J Fung, A Tzakis, S Todo, A. J Demetris, I. R Marino, H Doyle, A Zeevi, V Warty, S Kusne, W. A Rudert, M Trucco, M Michaels: Baboon-to-human liver transplantation. In: The Lancet, vol. 341, no. 8837, pp. 65 – 71, 1993, ISSN: 01406736, (Cited by: 358; All Open Access, Green Open Access).

Abstract

Our ability to control both the cellular and humoral components of xenograft rejection in laboratory experiments, together with an organ shortage that has placed limits on clinical transplantation services, prompted us to undertake a liver transplantation from a baboon to a 35-year-old man with B virus-associated chronic active hepatitis and human immunodeficiency virus infection. Liver replacement was performed according to conventional surgical techniques. Immunosuppression was with the FK 506-prednisone-prostaglandin regimen used routinely for hepatic allotransplantation, to which a daily non-myelotoxic dose of cyclophosphamide was added. During 70 days of survival, there was little evidence of hepatic rejection by biochemical monitoring or histopathological examination. Products of hepatic synthesis, including clotting factors, became those of the baboon liver with no obvious adverse effects. Death followed a cerebral and subarachnoid haemorrhage that was caused by an angioinvasive aspergillus infection. However, the underlying cause of death was widespread biliary sludge that formed in the biliary tree despite a seemingly satisfactory choledochojejunostomy. During life and in necropsy samples, there was evidence of the chimerism that we believe is integral to the acceptance of both xenografts and allografts. Our experience has shown the feasibility of controlling the rejection of the baboon liver xenograft in a human recipient. The biliary stasis that was the beginning of lethal infectious complications may be correctable by modifications of surgical technique. In further trials, the error of over-immunosuppression should be avoidable. © 1993.

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Chirurgia del Fegato all'Università di Firenze!

Chirurgia Epato-Bilio-Pancreatica

AOUC Azienda Ospedaliero-Universitaria Careggi
Largo Brambilla, 3 – 50134 Firenze

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