Liver transplantation today.

Orthotopic liver transplantation is a therapeutic option for patients with end-stage liver disease in whom conventional forms of medical therapy have failed. Since the first successful liver transplantation in 1967, more than 1000 have been done in North America and Europe. Improvements in patient selection, operative technique, and immunosuppression--most importantly, the introduction of cyclosporine--have resulted in an overall 1-year survival rate of 68%. Immediate postoperative problems are ischemic graft injury, acute rejection reactions, and technical problems with biliary and vascular anastomoses. Later complications include sepsis from bacterial, fungal, or viral pathogens due to immunosuppression. Late morbidity and mortality occur primarily because of chronic rejection or recurrence of primary liver disease. Despite the problems, liver transplantation is an exciting, nonexperimental therapy for patients with end-stage liver disease and offers hope to many patients for whom no treatment was previously available.