ABSTRACT

INTRODUCTION Since 1963, when Starzl performed the first liver transplant in a human, the procedure has become a standard of care in the management not only of decompensated acute and chronic liver disease but also of some tumors and metabolic disorders. The increasing acceptance of liver transplantation as a therapy reflects the dramatic improvement in outcomes following this procedure. In the last 20 years, the 1-year patient survival rate has improved from approximately 30% to 86%. Currently, the 5-year patient survival rate is 72%. Graft survival rates are generally about 10% less than patient survival rates (rates are from the United Network of Organ Sharing [UNOS], https://www.optn.org). The basis for the increase in patient and graft survival rates is complex but undoubtedly includes improved 1) patient selection (most early recipients had metastatic liver disease), 2) immunosuppression (<2% of livers are currently lost to chronic rejection), 3) surgical technique, and 4) expertise in related fields (e.g., intensive care, anesthesia, infectious diseases).