Liver transplantation

Orthotopic liver transplantation was first carried out by Thomas Starzl in 1963, and has become an established treatment for end-stage liver disease. About 11,000 transplants are done annually worldwide; the main source of donor organs is the brainstem-dead, heart-beating donor. There are few absolute contraindications to organ donation but, with the increasing waiting list mortality and waiting times, donor acceptance criteria have been liberalised and numerous technical variant grafts (reduced liver, split liver, living donor liver, domino liver) have been adopted to reduce this shortfall.The goal of liver transplantation is to prolong and improve quality of life in patients with advanced liver disease (acute or chronic end-stage liver disease). Selection and timing of referral for evaluation for liver transplantation optimizes outcomes. Patients are listed for transplantation after a complete assessment by a multidisciplinary team. The incidence of postoperative complications is influenced by the quality of the donor liver, technical aspects of the surgery, and recipient factors. Patient survival at one year and five years is 85–90% and 75–80%, respectively; graft survival is 80–85% and 70–75%, respectively. The main factor limiting further growth in liver transplantation worldwide is shortage of donor organs.