title: Irreversible liver failure: treatment by transplantation: part 3 of a series on liver cirrhosis.
abstract: BACKGROUND
  Liver transplantation is the only established, causally directed treatment for irreversible chronic or acute liver failure.
  
  
  METHODS
  This review is based on papers retrieved by a selective search in the PubMed database, the index of randomized controlled trials of the European Society of Organ Transplantation, and the Cochrane database, along with an analysis of data from the authors' own center.
  
  
  RESULTS
  1199 liver transplantations were performed in Germany in 2011. The most common indications were alcoholic cirrhosis (28%), cirrhosis of other causes (24%), and intrahepatic tumors (20%). Among recipients, the sex ratio was nearly 1:1 and the median age was just under 50. Across Europe, the 1-, 5-, and 10-year survival rates after liver transplantation were 82%, 71% and 61%. In our own center, the Charité in Berlin, the corresponding rates were 90.4%, 79.6% and 70.3%, based on an experience of 100 to 120 cases per year. The current rate of functioning transplants five years after liver transplantation is 52.6% in Germany and 66.2% internationally. Standard immunosuppression consists of a calcineurin inhibitor, tacrolimus or cyclosporine A, and steroids. Early complications include primary functional failure of the transplant, hemorrhage, thrombosis, acute rejection, and biliary complications. Over the long term, complications that can impair the outcome include chronic rejection, biliary strictures, cardiovascular and metabolic adverse effects, nephrotoxicity, neurotoxicity, and opportunistic infections and malignancies.
  
  
  CONCLUSIONS
  Liver transplantation is a successful and well-established form of treatment that is nonetheless endangered by a shortage of donor organs and other structural and organizational difficulties.
authors.affiliation: Department of General, Visceral, and Transplant Surgery, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Germany. andreas.pascher@charite.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Pascher
authors.forename: Maxim
authors.initials: M
authors.lastname: Nebrig
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
mesh_terms: D015897:Comorbidity; D006084:Graft Rejection / Q000401:mortality*; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality* / Q000601:surgery*; D017093:Liver Failure / Q000401:mortality* / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D015995:Prevalence; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome