[The present status and future of liver transplantation]

Since the introduction of cyclosporine the survival rate of orthotopic liver transplantation (OLT) has been dramatically improved (74% and 64% at one and 5 years reported from Pittsburgh). Additional contributing factors for this improvement are refinement of surgical techniques including using biopump for veno-veno bypass, introduction of OKT3 monoclonal antibody to treat acute allograft rejection, and adoption of new hepatic preservation fluid named as University of Wisconsin solution. There are, however, several continued threats of primary graft dysfunction, hepatic arterial thrombosis, early acute refractory rejection, and so on. Retransplantation is the only hope for these patients, the possibility of which is not negligible. The financial problem is also very large burden to OLT and the cost ranges from $135,000 to $238,000, which is twice of heart transplant and six times of kidney transplant. In our country the biggest barrier to starting OLT is social and medical agreement of brain death which seems hopefully coming close to resolution through persistent public discussion. Much more vigorous efforts should be made for the establishment of more efficient organ procurement system including donor card registration.