SINCE performance of the first human orthotopic liver transplantation in 1963, more than 540 such operations have been performed in four medical centers in the United States and western Europe. Additional liver transplantation procedures have been performed in other parts of the world and, more recently, in several other American medical centers. Although extremely demanding and expensive, the operation has been shown to be technically feasible, and interpretable results have been reported from all four primary transplant centers.
These clearly demonstrate that liver transplantation offers an alternative therapeutic approach that may prolong life in some patients suffering from severe liver disease that has progressed beyond the reach of currently available treatment and consequently carries a predictably poor prognosis. However, substantial questions remain regarding selection of patients who may benefit from liver transplantation; the stage of their liver disease at which transplantation should be performed; survival and clinical condition of patients