The level of success that we confidently expect in liver transplantation today directly results from several factors including surgical technique, the scientific use of immunosuppressive drugs and most importantly patient selection. The goal of an accurate selection is to recognize those patients that will benefit the most from the surgical procedure. This approach is crucial if we consider the limited availability of suitable donors. In general terms a patient with chronic liver disease and a Child Pugh score between 9 and 10 is considered suitable for grafting. Recent studies have shown that liver transplantation can be cost effective and lead to complete social and working rehabilitation provided that the 'timing' for the procedure is not inappropriately delayed. Medium term survival rates after liver transplantation (at 5 years) range between 60 and 80%. Disease recurrence greatly affects the morbidity and mortality after grafting. In patients transplanted for hepatitis B, active vital replication at the time of operation represents the strongest predictor of recurrence although the recent availability of antiviral nucleosids has provided effective prophylactic and therapeutic options. Recurrence of HCV infection is almost universal after transplantation but only 50% of the patients develop histologic hepatitis. The combination therapy with interferon and ribavirin has proved beneficial in modifying the natural history of recurrent disease. If untreated, recurrent hepatitis C can progress to cirrhosis in up to 15% of the patients. Lastly, the strict selection of patients undergoing liver transplantation on account of hepatocellular carcinoma has been associated with favourable results not different from those obtained with other indications
Belli, L., De Carlis, L., Alberti, A., Bellati, G., Rondinara, G., Forti, D., et al. (1997). Liver transplantation [II trapianto di fegato]. L'OSPEDALE MAGGIORE, 91(2), 174-182.
Liver transplantation [II trapianto di fegato]
De Carlis, L.;
1997
Abstract
The level of success that we confidently expect in liver transplantation today directly results from several factors including surgical technique, the scientific use of immunosuppressive drugs and most importantly patient selection. The goal of an accurate selection is to recognize those patients that will benefit the most from the surgical procedure. This approach is crucial if we consider the limited availability of suitable donors. In general terms a patient with chronic liver disease and a Child Pugh score between 9 and 10 is considered suitable for grafting. Recent studies have shown that liver transplantation can be cost effective and lead to complete social and working rehabilitation provided that the 'timing' for the procedure is not inappropriately delayed. Medium term survival rates after liver transplantation (at 5 years) range between 60 and 80%. Disease recurrence greatly affects the morbidity and mortality after grafting. In patients transplanted for hepatitis B, active vital replication at the time of operation represents the strongest predictor of recurrence although the recent availability of antiviral nucleosids has provided effective prophylactic and therapeutic options. Recurrence of HCV infection is almost universal after transplantation but only 50% of the patients develop histologic hepatitis. The combination therapy with interferon and ribavirin has proved beneficial in modifying the natural history of recurrent disease. If untreated, recurrent hepatitis C can progress to cirrhosis in up to 15% of the patients. Lastly, the strict selection of patients undergoing liver transplantation on account of hepatocellular carcinoma has been associated with favourable results not different from those obtained with other indications
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