15th Seah Cheng Siang Memorial Lecture: Liver transplantation--lessons learnt and future horizons

The first clinical successes with liver transplantation by Starzl in 1967 were based on studies showing that in man, organ allografts could induce self-tolerance with the aid of immunosuppression. Overall survival figures were poor until 1983, when cyclosporine was introduced into immunosuppressive regimes, and with the introduction of tacrolimus, results improved even further. With figures for 1-year survival now up to 90%, more attention is being directed to quality of life and the side effects of immunosuppression. Nephrotoxicity along with hypertension and diabetes are of major concern, and a significant number of long-term liver transplant patients are now facing end-stage renal failure. In the majority of conditions transplanted there is also a significant chance of disease recurrence in the graft. Owing to the shortage of cadaver organs, split liver and domino techniques are increasingly utilised. Living donor liver transplantation has also come to the fore, and to minimise potential harm to the donor, new techniques are being developed which will allow greater use of left lobe grafts.