Liver transplantation

Abstract Liver transplantation is now a widely accepted therapy for liver failure and complications from liver disease. The liver is complex with a multitude of synthetic, metabolic, excretory, and immunoregulatory functions. Understanding these and the pathophysiology of liver injury allows for better managing liver failure and recognizing the role for liver transplantation. When a patient with advanced liver disease is referred to a transplant centre, a multidisciplinary evaluation is undertaken which examines six things: indications, contraindications, cancer screening, anatomical evaluation, psychiatric assessment, and prioritization. Organ allocation systems such as the Model for End-Stage Liver Disease with sodium (MELD-Na) score are used to assess mortality risk and determine priority for transplant. After a liver transplant, there is a high potential for complications, and the key to improving outcomes and reducing mortality is to avoid these complications if possible, and effectively managing any that may occur. Additionally, it is imperative to manage immunosuppression to appropriately suppress the alloimmune response against donor alloantigen to prevent rejection, and also minimize side effects and avoid the drug toxicities that also impact survival. There has been great progress over the last five decades and both short- and long-term survival are excellent, with an approximately 92% survival at 1 year and 60% survival at 10 years.