Survival After Liver Transplantation
Clinical transplantation has had a dramatic evolution. As it enters its fifth decade, results have improved to the extent that transplant recipients are afforded outstanding survival odds. Following liver transplantation (LTX), 1-year patient and graft survival rates approach 90% and 80%, respectively. An overwhelming majority of patients survive the LTX procedure per se but face long-term challenges. A significant number of liver recipients are threatened by disease recurrence. All liver recipients suffer from the side effects of immunosuppressive therapy. In fact, the leading cause of death several years following LTX is cardiovascular disease. Cyclosporine (CsA) and tacrolimus (TAC) play a critical role in providing for the outstanding results following LTX, and they remain the backbone of current immunosuppressive regimens. However, these agents cause renal dysfunction, hypertension, diabetes mellitus (DM), hyperlipidemia, neuropsychiatric side effects, and other complications. As we embark into this fifth decade of clinical transplantation, a major challenge is to identify and utilize immunosuppressive agents and regimens with fewer toxicities so that liver recipients who now enjoy excellent short and intermediate-term survival can suffer less long-term morbidity and achieve improved long-term survival.