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 transplantation are now evidence-based and early referral is recommended, correlating with improved patient survival. The management of patients on the waiting list for liver transplantation is designed to prevent complications of 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 introduction into clinical practice of a variety of immunosuppressive agents has offered a bewildering array of therapeutic options but with a lack of evidence on which to select optimal immunosuppression. Similarly, difficulties remain in the treatment of some of the complications arising from liver transplantation such as recurrence of disease and complications of immunosuppression.