Liver transplantation at the University of Wisconsin

Abstract

Liver transplantation remains the only definitive therapy for patients with decompensated liver disease. Significant advances over the past 20 years in surgical technique, immunosuppressive agents, patient selection, and infection prophylaxis and treatment have led to improved patient and graft survival. The success of liver transplantation coupled with expanding indications has resulted in a marked shortage of donor organs. Our approach at the University of Wisconsin to address the shortage of liver allografts is to maximize organ donation and recovery, include the use of liver allografts from donation after cardiac death, the use of split liver transplant, and the use of living-donor liver transplant when necessary. Split-liver transplantation is an effective technique to expand the number of organs available for transplantation. Continued improvements in organ preservation remain a priority to maximize outcomes, especially when the use of marginal donors or split-liver transplantation is planned. Recipient selection criteria have been expanded to include older recipients as well as previous recipients of multiple allografts. Over time it has become clear that less intensive immunosuppression is required since many patients can be maintained on tacrolimus monotherapy. We remain committed to a continued evaluation of donor and recipient factors in order to maximize outcomes of liver transplantation, as well as a critical appraisal of current and newer immunosuppressive agents and their effects on long-term outcome and recurrent disease.