Liver transplantation.

Since the first human liver transplant done in 1963, the procedure has become a routine procedure with an excellent outcome in terms both of quality and of length of survival. The development and introduction into clinical practice of a variety of immunosuppressive agents has given the clinician a bewildering array of therapeutic options but with a lack of evidence on which to select for optimal immunosuppression. Tolerance can be reliably achieved in some animal transplants but remains to be achieved in humans. One of the major challenges facing the transplant community is the shortage of donor organs: imaginative approaches to overcome this problem include more effective use of marginal donor livers, splitting livers and development of living related transplants. While advances have been made in the field of xenotransplantation, there remain many hurdles to be overcome before this approach can be introduced into human transplantation. In the meanwhile, there are difficulties in determining the optimal criteria for listing patients for transplantation and for treating some of the complications arising after transplantation such as recurrence of disease and complications of immunosuppression, e.g. renal failure, malignancy and vascular disease.