[Liver transplantation. Selection criteria and risk evaluation]

The significant advances achieved in the last years in the field of liver transplantation have led to an almost routinely performance of this therapeutic approach throughout North America and Western Europe. This has led to an increased demand so that today the real problem is the organ availability and the need to use those supplied only for patients with best chances of success. For this reason timing of the operation and patient selection are of critical importance. The ultimate success depends on better surgical procedures and advances in immunosuppressive therapy, but perhaps even more on an accurate patient evaluation. The patient selection is based on standardized medical criteria which constitute the indication in patients with end-stage liver disease and on a careful search for risk factors. To this purpose the evaluation of the tolerance of the hemodinamic stress during clamping of the inferior vena cava is of critical importance and must be carefully evaluated both in patients with known and unknown coronary disease. Another condition to be considered is lung hypertension which is frequently associated with portal hypertension. Finally, important conditions for a good evaluation are the epatopulmonary syndrome and diabetes. The last condition is not a contraindication unless associated with severe vascular, cardiac or renal complications.