REVIEW – November 2010

Progress of liver transplantation in the world and its implementation in Estonia


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The basics of clinical liver transplantation today were generated first in several experimental laboratories in Europe and North America in 1955–1967. The 10 years experimental work ensured in the first successful liver transplantation in United States and one year later in Great Britain. Rapid progress in liver transplantation worldwide, particularly in Finland, since 1982, and active cooperation between the clinics of surgery of Helsinki and Tartu Universities as well as the Estonia’s need have contributed to the solution of the issue in Estonia. Considering international experience, we began preparation for clinical liver transplantation in Tartu in 1990 by improving the technique of orthotopic liver transplantation on a pig model developed by Calne. We performed the first successful liver transplantation in Tartu in 1999 using the classical technique  of orthotopic liver transplantation without a hepatic veno-venous bypass, as described by Höckerstedt and Calne. Between 1999 and 2009, the first 12 liver transplantations were performed in the Tartu University Clinic of Surgery. Eight of the patients were male and 4 were female aged 12 to 67 years. The diagnosis of the patients was primary sclerosing cholangitis, 4 cases; hepatocellular carcinoma, 2 cases; primary biliary cirrhosis, 1 case; HCV cirrhosis, 1 case; malignant hemangioendothelioma, 1 case; Budd-Chiari syndrome, 1 case; cystic fibrosis, 1 case and alcoholic cirrhosis, 1case. The rate of surgical complications (7/12) and the 75% (9/12) one-year posttransplant patient survival rate, with excellent life quality in the period of the implementation of liver transplantation, allows to continue its further development in Estonia.