[Liver transplantation in adults. Indications and results]

Liver transplantation is currently the standard treatment for terminal stage liver disease. Overall actuarial survival rate at 5 years is 65 to 70%. However, because of the increasing number of transplantations being performed throughout the world, the number of potential recipients exceeds the number of donor organs available. The long waiting lists thus imply rigorous candidate selection. At the same time, the indications for transplantation have evolved. In light of survival rates, certain indications, such as hepatitis B with viral replication before transplantation or hepatocellular carcinoma less than 3 cm in diameter, may be debatable. There are also new indications with excellent short-term results, such as alcoholic cirrhosis or hepatitis C cirrhosis. The long waiting lists have led to the development of intermediary management schemes: intrahepatic porto-systemic shunts to decrease portal pressure and facilitate subsequent dissection; neoadjuvant chemotherapy for hepatocellular carcinoma; or lamivudin to inhibit B virus replication. The limiting factor remains the lack of sufficient donor organs. It will not be possible to pursue wider indications unless the number of donors can be increased. This objective raises a vital challenge to the medical community.