Indications and results of liver transplantation]

More than 20,000 human liver transplantations have been performed world-wide. The procedure has become universally accepted by hepatologists and applied most broadly for numerous indications in end-stage liver disease. Most common indications for transplantation are benign liver diseases, leading to cirrhosis and/or liver failure. In non-resectable tumor stages liver transplantations have been less frequently performed. The main problem remains to define the "best timing" for the operation. The disease stage will influence the incidence of perioperative complications, postoperative mortality and survival after transplantation. Liver transplantation should be considered, before chronic liver disease reaches its final stage and extra-hepatic liver-related organ complications determine the course. "Ultima ratio" decisions in very late disease stages will leave the patient with only a small chance of surviving. High tumor recurrence rates and inferior survival figures after liver transplantation in malignant liver diseases necessitate a restrictive indication policy in such patients. Probably neoadjuvant chemotherapy in conjunction with liver transplantation will expand the therapeutic modalities in unresectable situations.