The Liver Transplant Patient Part 1: Managing Adults with Cirrhosis

Hospital Physician March 2007 19 O rthotopic liver transplantation is a surgical procedure in which the diseased native liver is removed and replaced with all or part of a healthy liver obtained from a deceased or living human donor. The first liver transplantation was performed in 1963. Initially, overall outcomes were poor and liver transplantation remained experimental. Following advances in immunosuppression in the late 1970s, survival improved dramatically, and in the mid1980s, liver transplantation began to move into the mainstream of clinical practice. Liver transplantation today is the established standard of care for many patients with end-stage liver disease. In 2005, more than 6400 liver transplants were performed in the United States at 119 sites.1 Transplantation is carried out in tertiary centers by teams of specialists experienced in caring for patients with advanced liver disease, performing transplant surgery, and managing posttransplant immunosuppression. However, every physician can expect to encounter liver transplant patients in clinical practice and should be familiar with some basic aspects of evaluation and management. This article is part 1 of a 2-part series on medical care of adults before and after liver transplantation. Part 1 discusses the primary care physician’s role of identifying patients with liver disease who may require liver transplantation and optimizing management of liver disease while the patient awaits transplantation. Part 2, to be published in the April 2007 issue of Hospital Physician, will review liver transplantation and discuss common health problems encountered in the posttransplant patient.