Clinical Developments and Current Immunological Research Approaches in Liver Transplantation

Abstract

It has only been within the last few years that liver grafting has gained world-wide interest and broad clinical application. The first phase of liver transplantation began 1967 with the first successful graft performed by T.E. Starzl in a child, and was followed by continous clinical employment of this procedure mainly by four centers (Denver/Pittsburgh, Cambridge, Hannover, Groningen) where, however, no more than 800 grafts were performed until 1983 [1, 2]. Since then more than 3000 liver transplants have been done in about 40 centers in Europe alone and an equal or even higher number in North America. The number of liver transplantations in Hannover and the distribution of the major groups are given in Fig. 1. During this development a marked improvement in results was achieved [3–7]. For some special indications and particularly in children, 1-year survival rates in the range of 80%–90% have been reached. For the majority of indication groups, however, the results are not so favorable and demonstrate that many problems still have to be solved. Although it is beyond any doubt that liver grafting is already a clinical treatment with high therapeutic value, its further development will depend very much on the success of current and future research activities in hepatology, organ preservation, evaluation of graft quality, and transplant immunology and immunosuppression.