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Liver Transplantation

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Abstract

Liver transplantation (LT) has evolved into a viable treatment option for patients with end-stage liver disease (ESLD) and acute liver failure (ALF). Advancements in allograft preservation, surgical technique, and the development of potent immunosuppressant drugs have allowed for marked improvements in posttransplant outcomes. One of the greatest challenges facing the field is the limited supply of allografts in relation to the rapidly growing prevalence of chronic liver disease. In order to more fairly and reliably stratify waitlisted patients, most LT centers worldwide have adopted organ allocation systems based on the model for end-stage liver disease (MELD) score, which has been shown to be an accurate predictor of pre-transplant mortality. Patients with an elevated MELD score or evidence of hepatic decompensation should be referred for evaluation at an LT center, which employs a rigorous multidisciplinary team approach to ensure appropriate patient selection. Despite increased overall survival, LT remains a formidable surgery. Awareness of the associated peri- and postoperative complications is crucial to maximizing outcomes. As a result of multidrug immunosuppression protocols, posttransplant mortality is rarely attributable to acute or chronic allograft rejection. However, infections are the most common cause of death in the early posttransplant period, and lifelong immunosuppression may be implicated in the development of malignancy, cardiovascular complications, and renal disease in later years.

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Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA, USA

    Nizar A. Mukhtar MD

  2. Swedish Medical Center/First Hill Campus, 747 Broadway, 98122-4307, Seattle, WA, USA

    Oren K. Fix MD, MSc, FACP

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  1. Nizar A. Mukhtar MD
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Correspondence to Oren K. Fix MD, MSc, FACP .

Editor information

Editors and Affiliations

  1. Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA

    Andrew P. Keaveny

  2. Institut de Malalties Digestives i Metaboliques, University of Barcelona, Barcelona, Spain

    Andrés Cárdenas

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Mukhtar, N., Fix, O. (2015). Liver Transplantation. In: Keaveny, A., Cárdenas, A. (eds) Complications of Cirrhosis. Springer, Cham. https://doi.org/10.1007/978-3-319-13614-1_27

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  • DOI: https://doi.org/10.1007/978-3-319-13614-1_27

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