Factors in the development of liver transplantation

Liver transplantation has become an accepted service during the last five years. The introduction of cyclosporine-steroid therapy has been the most important factor in making this possible. Improvements in surgical technique, including perfection of intraoperative venovenous bypasses and the standardization of biliary tract reconstruction have also contributed. Tissue typing and matching have played no role in improving the results of liver transplantation. With the demonstration that preformed antibody states are irrelevant, even avoidance of positive cross-matches caused by cytotoxic antibodies and observance of ABO blood group barriers have become unnecessary if the recipient's needs are great. The nature of the underlying hepatic disease has not profoundly influenced the results, with the exceptions of malignancy and cirrhosis. Retransplantation has played an important role in improving survival. The development of better methods of preservation that will allow the recipient operations to be done in a more leisurely manner and at more convenient times is the most pressing need for further application of liver transplantation at a national and international level.