Tailoring Immune Suppression Following Liver Transplantation

Liver transplantation was first performed in 1963 (1) as an experimental treatment for end stage liver disease. Three patients were transplanted, all of whom died within 3 weeks. Since then it has become an established therapy resulting in improved quality of life (2), with 675 transplants from cadaveric donors taking place in the UK in 2001 and 706 in 2002 (3). This level of activity compares with 10 years ago when 502 liver transplants were performed in 1992. Figures released for survival up to the year 2000 show that early (1 year) survival has improved to 88% for patients transplanted from 1998 – 1999, with 3 year survival for the period 1996 – 1997 being 73% and 5 year survival for the period 1994 – 1995 being 64% (3). This improvement is probably due to a combination of factors such as improved surgical and anaesthetic technique, changes in medical management after transplantation, the improved recognition of other harmful factors like hypertension, choice of immune suppression and better prediction of patients in whom liver transplantation is not likely to be appropriate such as those with cholangiocarcinoma or multiple large hepatocellular carcinomas. [Taken from Introduction]