LIVER-TRANSPLANTATION IN ADULTS INDICATIO NS AND RESULTS

Liver transplantation is currently the standard treatment for terminal stage liver disease, Overall actuarial survival rate at 5 Sears is 65 to 70%. However, because of the increasing number of transplantations being performed throughout tile world, the number of potential recipi ents exceeds the number of donor organs available, Tile long waiting l ists thus imply rigorous candidate selection, At the same time, the in dications for transplantation have evolved, In light of survival rates , certain indications, such as hepatitis a with viral replication befo re transplantation or hepatocellular carcinoma less than 3 cm in diame ter, may be debatable, There are also new indications with excellent s hort-term results, such as alcoholic cirrhosis or hetatitis C cirrhosi s, The long waiting lists have led to the development of intermediary management schemes: intrahepatic porto-systemic shunts: to decrease po rtal pressure and facilitate subsequent dissection; neoadjuvant chemot herapy for hepatocellular carcinoma; or lamivudin to inhibit B virus r eplication, The limiting factor remains the lack of sufficient donor o rgans. It will not be possible to pursue wider indications unless the number of donors can be increased, This objective raises a vital chall enge to the medical community.