LIVER-TRANSPLANTATION

Clinical papers published in 1995 and 1996 concerning liver transplant ation were reviewed and several recurring themes identified. There is an expanding discrepancy between available donor organs and the number of potential recipients, which has affected policies regarding alloca tion of organs and prioritizing of candidate recipients. The pool of c andidate recipients has expanded as a result of studies showing improv ed results, including transplantation for previously unfavorable group s such as patients with hepatoma or chronic viral hepatitis B. At the same time there have been modest innovations to expand the donor pool, using techniques to split donor organs, or to accept so-called margin al organs from elderly donors, or donors infected with hepatitis B or C. Most longterm mortality and morbidity results from consequences of inadequate or excessive immunosuppression-ductopenic rejection, opport unistic infection, lymphoma, or recurrence of the original disorder, p articularly viral hepatitis. Strategies to improve these results range from the innovative (auxiliary transplantation as a temporary support during fulminant hepatitis) to the evolutionary (refinement of immuno suppressive protocols, particularly with reduction in total doses of i mmunosuppressives after the first 3 months).