Technology assessment applied to liver transplantation in adults

This article is a review of liver transplantation in adults, in the context of ongoing technology assessments of the National Institutes of Health (NIH). Liver transplantation in adults has become an accepted therapeutic procedure for end-stage liver disease, as it is practiced in established programs of a number of experienced institutions. The number of medical centers instituting programs of liver transplantation has greatly increased since the 1983 NIH Consensus Conference on this subject, and this article traces the clear relationship between the experience level of the institution and the end result of adult transplantation. Five determinants of the survival rate, safety, and efficacy of liver transplantation are discussed: the supply of donor organs, the selection criteria for transplantation candidates, surgical technique, the support system and support staff available, and adequate suppression of the immunological response. Medical diagnoses most likely to produce successful results are enumerated.