Liver transplantation: current status and future prospects

The enormous progress that has been made in liver transplantation over the past two decades has culminated in survival approaching 90% at 12 months. T he success of the procedure combined with the widening spectrum of disease processes deemed amenable to liver transplantation has meant that there are too few donors for those awaiting transplantation. This has extrapolated t o many patients having such advanced disease by the time a suitable donor l iver is available, that they are almost non-transplantable. The immediate o ptions facing the transplant community are to decrease the number of patien ts listed or to increase the number of living donor transplants. Alternativ es to liver transplantation such as hepatocyte transplantation, gene therap y, xenotransplantation and the bioartificial liver are being sought but, at best, are some way from clinical application. It is anticipated that a num ber of liver diseases that are indications for liver transplantation at thi s time will have progression arrested or will be cured by medical therapy i n the future.