Liver transplantation in the ciclosporin era

During the last 5 years, liver transplantation has become a service as opposed to an experimental operation. The most important factor in making this possible has been the introduction of ciclosporin-steroid therapy. At the same time, liver transplantation has been made more practical by improvements in surgical technique, including perfection of intraoperative veno-venous bypasses and the standardization of biliary tract reconstruction. Tissue typing and matching has 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. With the exceptions of malignancy and cirrhosis, the nature of the underlying hepatic disease has not profoundly influenced the results. Retransplantation has played an important role in improving survival, although the costs of retransplantation have been extremely high. Many aspects of liver transplantation need to be improved including the development of better methods of preservation which will allow the recipient operations to be done in a more leisurely manner and at more convenient times.