O Abbasoglu, MF Levy, Brkic BB, et al (Baylor Univ, Dallas. Tex):
Ten years of liver transplantation: An evolving understanding of late graft loss.
Transplantation 64: 1801-1807, 1997.
Despite progress in long-term outcome of orthotopic liver transplantation (OLT) , late graft loss is still a concern. OLT patients who live beyond the first year have excellent survival rates. The main causes of late graft loss are recurrent diseases, new malignancies, cardiovascular diseases, and stroke.
J. Belghiti and F. Durand [ Departments of Digestive Surgery and Hepatology, Hospital Beaujon, University Paris VII, 92118 Clichy Cedex, France
Living Donor Liver Transplantation : Present and Future
Br. Jour. of Sur. Volume 87, No.11, November 2000, Pgs- 1441-1443
Living donor liver transplantation has been an acceptable modality of therapy for ten years now. The progress in this field has been seen mainly in Japan. [ Almost 1000 such procedures have been done] because of absence of cadaveric donors and the technical expertise of south east surgeons in hepato biliary surgery. As a result of this, left hepatectomy for living donation for children and small adults has almost become routine. The results of living donation proved to be better than cadaveric donation in pediatric cases. This was attributed to factors other than immunological ones because the need for immunosuppression and the incidence of rejection were almost similar. The non immunologic factors contributing to better results were likely to be  good quality of graft  very short period of cold ischaemia  the ability to plan the procedure both from the availability of surgical expertise and choosing the optimal time for the recipient. The good results of this procedure illustrate its superiority over the partial graft procedure.
However in adults this procedure is problematical. Several reports suggest that a liver graft representing less than 0.8% of the recipients body weight has a high risk of failure. As a result an attempt is now being made with right side grafts in adults. This has raised some concerns [ 1] It carries a potential 200% mortality risk  Complications such as peptic ulcer and pulmonary embolism remain a major concern, in addition to the development of coagulation disorders.  The number of adults awaiting liver transplantation is ten times higher than children and this poses a major problem of donor availability, donor morbidity and mortality.
This has led to efforts to set up definite guidelines aimed at selection of recipient. Those at high risk are therefore kept out or excluded, which can be misconstrued; it may not be applicable to those who have their own donors available. More centers therefore need to be developed to address the increasing demand.
Then there is the psychological dilemma as, in the absence of living donation a patient may be condemned to die without a transplant. Again relatives who have participated in a palliative transplantation may face psychological morbidity because life expectancy may be very short.
Finally, in order to prevent commerce in transplantation, living donation has been limited in several European countries to first degree relatives with the possibility of extension to spouses in emergency situations. In France, – bioethical law – [informed consent of potential living donor has to be given to a judge] gives added protection against commerce in transplantation.
A. OBichere, S. Shurey, P. Sibbons, C. Green and R.K. S. Phillips [ St Marks Hospital and Northwick Park Institute for Medical Research, Harrow, UK]
Expertimental Model of Anorectal Transplantation
Br. Jour. of Sur. Volume 87, No.11, November 2000, Pgs- 1534-1539
This study investigates the possibility of anorectal transplantation with pudendal nerve and inferior artery and vein anastomosis in a porcine model. This would avoid a colostomy and recreate potentially normal anorectal function.
Four female pigs provided donor anorectum for four male recipients under standard general anaesthesia. The donor operation involved abdominoperineal excision of rectum [APR] taking the anal sphincter, pudendal neurovascular bundle and inferior mesenteric vessels. The recipient underwent APR, transperitoneal introduction of donor graft, anastomoses of rectum, inferior mesenteric vessels and pudendal neurovascular bundle, and perineal closure.
The duration of each slip, ischaemic time, dimensions of anastomosed structures and postoperative graft viability was recorded. The animals were killed at 24 hours, the state of the graft was noted and tissue was taken for confirmatory histology.
The mean operation time was 372 min. the mean ischaemic time was 118 min. Before death, 2 grafts were pink, 1 was dusky, and one was an outright failure.
Anorectal transplantation is technically feasible in a pig model. Long-term studies are needed to assess return of function and to overcome rejection.