Liver transplantation

Continued discussion over organ allocation and distribution remained a foca l point in the field of liver transplantation in the year 2000. Despite the ongoing debate, no significant changes were implemented in the current all ocation system. By far, the most widely discussed topic in liver transplant ation this year was live donor adult-to-adult liver transplantation. Severa l authors reported on their initial experience, with both recipient and don or outcomes appearing excellent. As the number of transplant centers perfor ming this procedure increases we look forward to further studies regarding the safety and long-term outcome of this innovative procedure. Studies on v iral hepatitis after liver transplantation again focused on the problem of recurrent hepatitis B and hepatitis C, Several small studies found benefit in patients with hepatitis B treated with intramuscular hepatitis B immunog lobulin and lamivudine after transplantation. Although breakthrough replica tion remains a problem in some patients, these studies offer hope that comb ination therapy for hepatitis B may provide improved long-term graft surviv al in these patients. In patients with hepatitis C, several studies focused on identifying risk factors to predict graft recurrence of the virus after liver transplantation. Both cellular rejection and level of viral replicat ion may be important predictors of recurrent hepatitis C virus in the graft . Early treatment reports using interferon and ribavirin suggest that some patients may have a viral response during therapy; however, it is short liv ed, and tolerance of medication is difficult. Certainly, we look forward to further studies looking at means of prevention and treatment of viral hepa titis in patients undergoing liver transplantation. Curr Opin Gastroenterol 2001, 17:299-303 (C) 2001 Lippincott Williams & Wilkins, Inc.