Orthotopic liver transplantation has become a routine treatment for endstage liver disease, and the number of transplants is only limited by the supply of donor organs. Five-year survival rates in excess of 80 per cent are now common for elective procedures ( Fig 1 ). Factors which have contributed to this success include earlier referral for transplantation, better preoperative preparation, advances in anesthetic and surgical techniques, and skilled perioperative intensive care management, particularly in the case of physiologically unstable patients and those with fulminant hepatic failure.

Fig. 1 Five-year survival by diagnosis following orthotopic liver transplantation (Birmingham 1988-1996): ALD, alcoholic liver disease; HCV, hepatitis C virus; PBC, primary biliary cirrhosis. (Data from the Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.)

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