[Liver transplantation: current status]. / Levertransplantatie: actuele status.

ABSTRACT

The liver transplantation has become in hepatology, what kidney- and heart transplantation are for a longer time in nephrology and cardiology. Liver transplantation is a final treatment for an important number of chronic and acute liver diseases as well as for a whole series of metabolic disorders the cause of which is situated in the liver. The important development of the liver transplantation is due to the introduction into clinical practice of the new immunosuppressive drug Cyclosporin, the development of new surgical techniques as well for the procurement as for the transplantation of organs, the improvement and standardization of perioperative care, the introduction of the concept of retransplantation and the use of liver segments for transplantation as well in children as in adults. Every candidate for liver transplantation has to be treated in function of the eventuality of a later transplantation. The introduction of interventional radiological techniques for placing intrahepatic portosystemic shunts and effecting percutaneous dilatation of diffuse bile-duct strictures are important measures which make it possible to carry out later on the transplantation with fewer risks. The poignant lack of organs reduces the progress of transplantation. To make aware of the importance of organ donation not only the public, but also the medical and paramedical staffs is a determining factor in the future of organ transplantation. That lack of organs will be otherwise a good stimulus for inciting the medical staff to consider the indications very strictly; this is especially important in alcoholic cirrhosis, in hepatobiliary carcinoma and in patients with an unfavourable psychosocial context. In future we shall have to watch over the reservation of good organs for the "best" patients. The future financial restrictions in medical matters will also need strict consideration in order to avoid disproportionate costs for transplantation in patients who have poor or even few chances to survive for some time as stated in the "Paris Consensus Conference" of June 1993. All this shows how deeply liver transplantation will influence not only today's Medicine, but also the whole of Society, because it constantly interferes with financial and ethical problems of our modern society.