INTRODUCTION

Liver transplantation has emerged over the past several decades as a viable treatment option for patients with acute liver failure and end-stage liver disease. Initial progress and growth were limited by technical difficulties and an inherent learning curve in the management of patients in the post-transplantation period. Improvements in transplantation outcomes have yielded a greater treatment demand and a new challenge, organ shortage.

Although liver transplantation has proven to be a great success in a relatively short period of development, it should not be considered as either the initial or primary treatment modality for most liver diseases. Other than in a few specific disorders, transplantation is a therapy for disease complications rather than of the primary illness.

Transplant infrequently cures the underlying disease; recurrent liver disease after transplantation occurs in anywhere from 0 to 100 percent of patients depending upon the disease for which transplant was performed. In a patient with acute liver failure secondary to drug related injury, recurrence does not occur provided that the offending agent is avoided. However, in a patient with chronic HCV, recurrent disease is expected.

Thus, the selection of a transplant candidate is a risk-benefit analysis, in which the inherent risks of surgery, recurrent disease, and long-term immunosuppression must be weighed against the potential benefits of transplantation. These benefits differ for each patient but include improvements in survival, prevention of long-term complications, and better health-related quality of life.

INDICATIONS

The Clinical Practice Committee of the American Society of Transplantation has attempted to identify and define criteria for the non-transplant clinician on indications for and timing of solid organ transplantation [1].