Liver Transplantation

The field of liver transplantation has undergone remarkable advances in the last two decades. An essentially experimental procedure in the early 1980s, a liver transplant is now the treatment of choice for patients with acute and chronic liver failure. Patient survival at 1 year posttransplant has increased from 30% in the early 1980s to more than 85% at present. The major reasons for this dramatic increase include refined surgical and preservation techniques, better immunosuppressive protocols, more effective treatment of infections, and improved care during the critical perioperative period.Yet a liver transplant remains a major undertaking, with the potential for complications affecting every major organ system.

The history of liver transplantation began with experimental transplants performed in dogs in the late 1950s. The first liver transplant attempted in humans was in 1963 by Thomas Starzl. The recipient was a 3-year-old boy with biliary atresia,who unfortunately died of hemorrhage. The first successful liver transplant was in 1967, again by Starzl.Yet, for the next 10 years, liver transplants remained essentially experimental, with survival rates well below 50%. Still, advances in the surgical procedure and in anesthetic management continued to be made during that time. The major breakthrough for the field came in the early 1980s, with the introduction and clinical use of the immunosuppres-sive agent cyclosporine. Patient survival dramatically improved, and liver transplant was soon being recognized as a viable therapeutic option for patients with liver failure.Results continued to improve through the 1980s, thanks to ongoing improvements in immuno-suppression,in critical care management,in surgical technique,and in preservation solu-tions.The late 1980s and 1990s saw a dramatic increase in the number of liver transplants. However,there was an even greater increase in the number of patients waiting for a transplant, which in turn increased waiting times, as well as mortality rates while waiting.