Liver transplantation

The growing disparity between available organs for liver transplantation and the number of waiting recipients has prompted significant debate over organ allocation and distribution. In light of this debate, recipient selection and prediction of factors relating to outcome have become increasingly important. Current immunosuppressive regimens provide excellent short-and long-term survival for patients and grafts. Increasingly, efforts are being made to decrease or withdraw immunosuppression late after transplantation to minimize long-term side effects. Viral disease, particularly cytomegalovirus infection, results in significant morbidity and mortality in patients. However, strategies for targeting high-risk patients with prophylactic antiviral therapy have been successful in reducing the incidence of cytomegalovirus disease. Recurrent viral hepatitis following liver transplantation may limit long-term graft success. Lamivudine appears to limit recurrent infection with hepatitis B virus in a significant number of patients who develop this condition following liver transplantation and may represent a cost savings over hepatitis B immunoglobulin. Although the overall survival of patients with chronic hepatitis C virus infection after orthotopic liver transplantation is excellent, significant morbidity and mortality occur in the subset of patients with severe recurrent disease. Interferon may delay the onset of disease in patients infected with hepatitis C virus following orthotopic liver transplantation, and investigation continues into antiviral therapy in this group of patients.