Update in liver transplantation.
OBJECTIVE
To review recent developments in liver transplantation with particular emphasis on issues relevant to patient care before and after transplantation.


METHODS
Preference was given to recent studies with well-designed cohort methods and large numbers of study subjects. Data on natural history are summarized from large databases in Canada and the United States. Due to the nature of the subjects involved, most treatment studies are open studies or consecutive series rather than randomized controlled trials.


RESULTS
Substantial advances in liver transplantation have established it as an effective treatment for most end-stage liver diseases, with 1-year survival rates higher than 85% in many centres. Early referral by family physicians and careful patient selection by transplant centres remain crucial to continued success. Managing these patients requires special care from family physicians because of post-transplantation immunosuppression, increased risk of opportunistic infection, and transplantation-associated medical problems. Other unresolved issues include recurrence of disease (hepatitis B and C, and malignancy) and an ongoing shortage of organs.


CONCLUSIONS
Liver transplantation is an effective form of therapy for end-stage liver disease, improving both patients' likelihood of survival and their quality of life. Because medical care of liver transplant patients is so complex, coordinated efforts between primary care physicians and transplant teams are crucial.
Wong
W W
WW
Department of Medicine, University of Alberta, Edmonton.
Bain
V G
VG
D000328:Adult; D000075202:Contraindications; D004347:Drug Interactions; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016031:Liver Transplantation; D008297:Male; D008991:Monitoring, Physiologic; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D018579:Patient Selection; D010821:Physicians, Family; D011182:Postoperative Care; D011247:Pregnancy; D012017:Referral and Consultation; D020123:Sirolimus / Q000627:therapeutic use; D015996:Survival Rate
D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D020123:Sirolimus