Liver transplantation at the millennium. Past, present, and future.

During the past 3 decades, liver transplantation has achieved such acceptance that more than 12,000 qualified recipients are listed for liver transplantation in the United States, but unfortunately just over 4000 cadaver donor organs are available each year. Thus, given the increasing disparity between the number of potential recipients and available cadaver organs, the current challenge in liver transplantation is to optimize the outcome of liver transplantation from this limited resource. Currently under way is re-evaluation of selection criteria to use these 4000 cadaver liver grafts most effectively by striking the proper balance between medical urgency and utility. In parallel with this re-evaluation, there is ongoing expansion of cadaver split-liver transplantation and adult living related and unrelated liver transplantation. Hoped-for but as yet unachieved developments in liver transplantation are xenotransplantation, hepatocyte transplantation, and liver-directed gene therapy. Liver transplantation has come a long way from the initial, unsuccessful human transplantations in 1963, but many challenges remain.