Liver transplantation: where it's been and where it's going.

The ultimate therapeutic step in the treatment of hepatic disease is the provision of a new liver with or without removal of the affected native organ. As of the writing of this manuscript, nearly 2000 liver transplants have been performed in the United States alone. Probably another 1000 have been performed in other parts of the world. Two approaches to liver transplantation have been utilized. The first consists of the insertion of an extra liver (auxiliary liver transplantation) at an ectopic location. This approach leaves the recipient's diseased liver intact. The alternative approach to auxiliary hepatic transplantation is orthotopic liver transplantation. With this operation, the diseased liver is removed, creating a space into which the allograft is transplanted with as normal an anatomic reconstruction as is possible based upon the specific liver pathology and the prior surgical history of the recipient.