Liver transplantation

The growing disparity between available organs for liver transplantation an d the number of waiting recipients has prompted significant debate over org an allocation and distribution. In light of this debate, recipient selectio n and prediction of factors relating to outcome have become increasingly im portant. Current immunosuppressive regimens provide excellent short- and lo ng-term survival for patients and grafts. Increasingly, efforts are being m ade to decrease or withdraw immunosuppression late after transplantation to minimize long-term side effects. Viral disease, particularly cytomegalovir us infection, results in significant morbidity and mortality in patients, H owever, strategies for targeting high-risk patients with prophylactic antiv iral therapy have been successful in reducing the incidence of cytomegalovi rus disease. Recurrent viral hepatitis following liver transplantation may limit long-term graft success. Lamivudine appears to limit recurrent infect ion with hepatitis B virus in a significant number of patients who develop this condition following liver transplantation and may represent a cost sav ings over hepatitis B immunoglobulin. Although the overall survival of pati ents with chronic hepatitis C virus infection after orthotopic liver transp lantation is excellent, significant morbidity and mortality occur in the su bset of patients with severe recurrent disease. Interferon may delay the on set of disease in patients infected with hepatitis C virus following orthot opic liver transplantation, and investigation continues into antiviral ther apy in this group of patients. (C) 1999 Lippincott Williams & Wilkins, Inc.