Liver transplantation of patients in end-stage cirrhosis

The success of liver transplantation has resulted in its widespread use for end-stage liver disease; 1- and 5-year survival rates of 70-90% and 60-80% respectively have been reported. Indications for assessment for liver tran splantation are now evidence-based and early referral is recommended, corre lating with improved patient survival. The management of patients on the wa iting list for liver transplantation is designed to prevent complications o f liver disease and to avoid therapeutic misadventures. Following transplantation, rejection and infection dominate post-operative complications, and improvements in their prevention and treatment have also correlated with improved patient survival. The development and introductio n into clinical practice of a variety of immunosuppressive agents has offer ed a bewildering array of therapeutic options but with a lack of evidence o n which to select optimal immunosuppression. Similarly, difficulties remain in the treatment of some of the complications arising from liver transplan tation such as recurrence of disease and complications of immunosuppression .