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| Volume 73 Number 8 December 2006 |
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| Grand Rounds Update On Liver Transplantation: Indications, Organ Allocation, and Long-Term Care |
1056-1066 |
Patricia M. Lopez, M.D.1, and Paul Martin, M.D.2 |
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1Assistant Professor of Medicine and 2Professor of Medicine, Division of Liver Disease and Recanati Miller Transplant Institute, Mount Sinai Medical Center, New York, NY.
Address all correspondence to Patricia M. Lopez, M.D., Division of Liver Disease and Recanati Miller Transplantation Institute, Box 1104, One Gustave L. Levy Place, New York, NY 10029.
Adapted from a Grand Rounds presentation to the Department of Medicine, Mount Sinai School of Medicine, New York, NY on February 1, 2005, and accepted July 2006.
Abstract
Liver transplantation (LT) is definitive treatment for patients with acute liver failure and end- stage liver disease and in a subset of primary hepatic malignancies. For patients who successfully undergo LT, the probability of long-term graft and recipient survival is generally excellent, with a high likelihood of return to a relatively normal lifestyle. This article will review current indications, contraindications and postoperative care in LT. With the number of potential recipients far exceeding the number of deceased donor organs, new strategies are being explored to increase access to LT, including: splitting cadaveric donor livers, the use of living donors, and the adoption of the Model for End-Stage Liver Disease (MELD) scoring system, which is based on a mathematical formula to stratify patients in greatest need of transplantation. The allocation of deceased donor organs will, however, remain a contentious issue unless the donor pool is greatly expanded.
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