Indications for liver transplantation

The first human liver transplant was performed in 1963. Since then, outcomes have dramatically improved, and liver transplantation (LT) is now an effective treatment for both acute and chronic liver failure, with 1- and 5-year survival rates greater than 90% and 70%, respectively. Most transplant centres require a minimum period of 6 months abstinence. Alcoholic hepatitis remains a contraindication to LT in most centres, but data from France and North America have suggested a role for LT in selected patients who are unlikely to survive the 6-month period of sobriety. There is no upper age limit for LT. However, in older patients there is an increased likelihood of comorbidities especially malignancy and heart disease. Each patient requires a multidisciplinary, holistic assessment to determine whether they are able to tolerate the stress of surgery, long-term immunosuppression and are committed to long-term LT care.