[Liver transplantation in adults]

Liver transplantation allows to treat patients with end-stage cirrhosis as well as some liver malignancies (small size hepatocellular carcinoma) with a life expectancy exceeding 70 and 60 % at 5 years, respectively. Current immunosuppressive agents make it possible to prevent chronic rejection in more than 90 % of the patients and to preserve an excellent quality of life in most cases. The principal limiting factor for liver transplantation is represented by the scarcity of brain-dead donors. Indeed, despite the selection of those candidates who have the best chance of surviving after transplantation, several months are usually necessary for obtaining a graft and the mortality on the waiting list may reach 10 to 15 %. Organ shortage incited to develop alternatives to conventional transplantation, the most important of which are living donor transplantation and split liver transplantation. Living donor transplantation can be applied to about 20 to 30 % of candidates. Thought initially smaller, the partial graft regenerates and its volume is restored within a few weeks. The results of living donor transplantation in terms of survival are comparable to those of cadaveric transplantation. The risk for the donor has to be lower than 1 % which makes that selection must be especially cautious. Donors must be direct relatives or spouses. Split liver transplantation technique, based on the separation of a cadaveric graft into two functional parts transplanted in two distinct recipients, although attractive, is applicable to less than 25 % of the donors. Education for organ donation in the general population still remains a priority.