الفهرس 
Indications of liver transplantationOnly 14 pages are availabe for public view
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Abstract
Liv•r transplantation is now th•tr•atm•nt of choic•for
childr•n and adults Immunosuppr•ssiv• th•rapv bas•d on c closporin•-pr•dnison• has tipp•d
th•seal•• mer•than anv other factor , but improv•m•nts in organ proc:urem•nt techniques and in
th•recipi•nt op•ration hav•also contribut•d •
The •xt•nt to which patient ••l•ction can influence results of transplantation is hard to assess •
As results hav•
improved • th•r•is increased justif ication for avoidance of invasive and l•••eff•ctive alt•rnative
treatments and for
•arl i•r referral of pati•nts to th•transplant center It is also cl•ar that l iv•r transplantation
is of l imited , if anv , benefit for most pati•nts with primarv h•patic mal ignanc v and for
moribund patients in the terminal phase of advanced liver
Liver transplantation is costlw t and th•suppl w of donor organs is l•••than the demand for them
Should prioritization of candidat•s for l iv•r transplantation be based on the probabi litv of
success or on th•urgencv of need? Except at extreme ends of th•spectrum it is diff icult now to
quantif y risk • It was d ifficult for most patients to pred i ct the l ikel ihood of success based
on perioperative assessment of risk • Manv patients who might seem to be at high risl<sotan
excellent chance for survival in the hand of a sk il led transplant team
Giv•n th•unc•rtainti•• of pr•d ictin9 outcom•b•••d on risk 1 w•continu•to ••l•ct pati.nts for liv•r
transplant•tion bas•d on th•urg•ncy of n••d but with congnizanc• of tho••
•xtr•m• circumstanc•• in which transplantation would b• wast•ful and inappropriat• • This plac••
us und•r constant pr•s•ur•not to n•g l•ct th•provr•••ion of illn••• in pati•nt• who hav• accru•d
months of waiting on th•candidat•l ist and
•nabl•s us to off•r transpl•ntation on •basis th• phwsicians ,
pati•nts
t famili•• and th•v•n•ral publ ic can acc•pt as
•quitabl• •
Sine•th•introduction of cwclosporin•-pr•dnison•th•rapw in March 1990 , manw prim•rw orthotopic
liv•r transplants hav• b••n p•rform•d • Actuarial survival•at 1 and 5 w•ars h•v• improv•d to 69.7
p•r c.nt and 62.B p•r c•nt , r••p•ctiv•lw
Bi liarw atr••ia i• now th•most common indication for l iv•r r•plac•m•nt In adults , primarw b i
liary cirrhosis and scl•rosing cholangiti• hav•b•com•mor•common indications for transplantation and
alcohol ic cirrhosis and primary liv•r mal ignancw as indications hav•d•cl in•d • Early •nthusiasm
for liv•r transplantation in pati•nt•with h•patic canc•r hav•b•en t•mp•r•d by the finding that
recurr•nce is both common and rapid • An increasing numb•r of pati ents with inborn •rrors of
metabol ism originating in the l iver ar•r•ceiving transplants
including patients with Wi lson’s d isease , trosinemia ’
alpha-1-antitr psin deficiency g l cogen storage disease
fami l ial hyperchol esterolemia 1 and hemochromatosis Survival in th is groL1p of patients has
been excel lent < 74,4 per cent at 1 and 5 years > •
About 20 per cent of patients require retransp lantat ion for reject ion , technical failure , or
primary graft fai lure
An aggressive approach to retransplantation in the pat ient with a fai led graft is justified •