Liver transplantation in humans.
The first liver transplantation on a human in Norway was performed in summer 1969 at Ward 2, Ullevål hospital. The patient was a man in his forties with liver cirrhosis, oesophageal varices and profuse gastrointestinal bleeding. He had been operated on with gastric transection and a Sangstaken-Blakemore tube was placed in the oesophagus. He was in liver coma when a man with severe head injury was admitted to Ward 3, Ullevål hospital who was regarded as being beyond curative treatment. It was decided to switch off the ventilator. He was accepted as a donor by both Snorre Aune and the head of Ward 3, Frank Bergan (1909 – 1985). The operation lasted for 545 minutes and was technically difficult with significant bleeding problems. The recipient died at 07:00 the next morning.
The next patient was a woman in her forties who underwent a liver transplant in winter 1970. She had carcinoma of the colon with liver metastases and requested a transplantation. Her primary tumour had been excised radically and there were no other metastases, so that a successful liver transplantation could theoretically be curative. The first operation lasted 570 minutes. She was then re-operated twice within a short period, with cholocysto-jejunostomy (210 minutes) and splenectomy (320 minutes). Altogether the patient was operated on for 1100 minutes, or nearly 21 hours. I remember that we worked continuously for 35 hours with short periods when the patient was off the table. There were considerable problems with bile duct anastomoses and with bleeding. Snorre Aune was the lead surgeon throughout, with Gunnar Schistad, Morten Ræder and myself as assistants. Alas, the case notes are lost but from the operating protocol it can be seen that she was operated on again two weeks after the transplantation (120 minutes) and then five days later (160 minutes), both times with Snorre Aune as the lead surgeon. She died a few days after this last operation from a fulminating sepsis, 24 days after the transplantation. The case was reported by Snorre Aune, Gunnar Shistad and Andres Skulberg in which they discussed whether this patient should have been treated with azathioprine, «which is poorly tolerated by human liver recipients.» instead of with corticosteroid as the only immunosuppressive treatment (10).
The third liver transplantation was performed in summer 1972, eighteen months after the previous one. The patient was a man in his sixties with liver cirrhosis and bleeding oesophageal varices. He had undergone gastric transection, and was in liver coma when he underwent his transplantation. On this occasion Jan Stadås (1934 – 2011) also assisted during the operation, which lasted 425 minutes and was without complications. The patient woke up, was mentally clear, emerged from his liver coma and the transplanted liver functioned. On the fourth day postoperatively he showed signs of rejection and was put on dexamethasone 16 mg daily. There was a temporary fall in his transaminase but his bilirubin, alkaline phosphatase and gamma GT continued to rise. The dexamethasone dose was doubled and his liver function was then acceptable, with serum levels for albumin, fibrinogen, cholesterol and lactate/pyruvate within normal values. The patient was out of bed, in relatively good condition and with a good appetite. However, he developed a large duodenal ulcer resulting in a sudden, fatal gastrointestinal haemorrhage, and he died 53 days after the transplantation. At autopsy the liver appeared normal with a glossy, shining surface and all anastomoses were intact (11, 12).