Liver transplantation

Huge developments in the field of liver transplantation have occurred over the last 30 years. Improved immunosuppression regimens brought about by the introduction of ciclosporin and tacrolimus, the development of organ preservation solutions and enhanced perioperative care have meant that survival at 1 year following liver transplantation now reaches approximately 90%. The spectrum of disease now treated with liver transplantation has also grown to encompass a wide range of chronic disease and primary liver malignancy. Early referral to specialist centres affords better outcomes for potential recipients and has prompted the development of specific scoring systems to objectively assess liver failure and guide organ allocation. The consistent gap between the number of recipients and availability of organs, however, has driven many new developments such as split grafts and live donor transplantation. The use of the marginal graft is now commonplace in many centres in an attempt to reduce waiting list mortality. Here, we examine the origins and evolution of the specialty and describe some of the latest developments in the field of liver transplantation, with specific reference to the surgical techniques currently used as well as recent advances in immunosuppression therapy.