[Who are the candidates for liver transplantation?]

Over the past 12 years, new immunosuppressive agents, better knowledge of anesthesiology and postoperative reanimation as well as refinement in surgical technics modified the indications for and results of orthotopic liver transplantation (OLT). At the beginning of the OLT era, liver tumors that could only be removed by total hepatectomy were one of the most frequent indications. Nowadays, this indication is mostly abandoned in view of a high rate of recurrence and poor long-term results. In contrast, the prognosis of fulminant hepatic failure has been dramatically improved by OLT, once efficient organization systems allowed adequate organ supply and emergency transplantation within a few hours. Three main groups of diseases (cholestatic diseases, inborn errors of metabolism and parenchymal diseases) can be treated by OLT with excellent results (actuarial survivals of 80 to 90% have been reported at one and 2 years). Later graft dysfunction is rare except for virus B recurrence. Primary biliary cirrhosis and the group of inborn errors of metabolism are regarded as the optimal indications of OLT in adults and children respectively. Precocious evaluation of patients, before advanced stages of the disease associated with multiple complications, should prevent them from dying on a waiting list and decrease operative as well as early postoperative risks. Not only does OLT provide mere survival (among 5 patients with lethal hepatic disease, 4 are alive at 2 years from OLT), it also provides a regained quality of life with a virtually normal (for the price of a daily medication intake) family, professional and sportive life. Such achievements prompt us today to propose early transplantation to these patients.