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Recent advances in clinical practice
Developments in liver transplantation
  1. J Neuberger
  1. Correspondence to:
    Professor J M Neuberger
    The Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, UK; James.Neubergeruhb.nhs.uk

https://doi.org/10.1136/gut.2003.024927

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    In the last few years, there have developments in many aspects of liver transplantation. This review will focus on those areas where adult clinical practice has developed1–3; the topics selected are those which, it is hoped, will be of interest and relevance to those health care professionals who refer patients to transplant centres and share in their follow up. In such a review, it is not possible to be comprehensive.

    CHANGING INDICATIONS (TABLE 1)

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    Table 1

    Transplant activity and indications in Europe (data from the European Liver Transplant Registry, kindly provided by Dr Vincent Karam)

    Indications for transplantation are evolving: liver failure from hepatitis C virus (HCV) infection and alcohol now represent the commonest indications for liver transplantation both in Europe and North America (table 1).

    Alcoholic liver disease (ALD)

    ALD remains a controversial indication for liver transplantation and adverse publicity surrounding selected high profile cases can impact on organ donation. None the less, both short and long term outcomes in those transplanted for ALD are similar to those seen in patients transplanted for other causes of cirrhosis, with respect to survival and quality of life. However, this simplistic analysis takes no account of case mix (see box 1).

    Box 1 Alcoholic liver disease

    • Alcoholic liver disease remains a good indications for liver transplantation with survival similar to those for other indications.

    • Indications for transplantation need refining as estimated short term gain is small.

    • The role of transplantation for alcoholic hepatitis is uncertain.

    • Transplantation is not indicated in those who are likely to return to a pattern of drinking that will either result in graft damage or lead to non-compliance.

    • The number of reported cases of graft damage or loss associated with a return to alcohol is small.

    • Potential candidates need to be assessed by a multidisciplinary team.

    • A fixed period of abstinence is not indicated but …

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