Liver transplantation: indications and pre-operative prognostic factors.
Liver transplantation is now increasingly being accepted as a valuable and effective way of greatly improving not just the survival of patients with major hepatic disease but also their quality of life. Rehabilitation is excellent after liver replacement and if increasing success is to be achieved with greater numbers of young people rehabilitated an increasing awareness of the benefits should be matched by an early review and discussion in order to reduce the high proportion of patients still being referred for replacement in the agonal phase of their disease at a time when the morbidity and mortality of the procedure remains high. The balance between intervention which is "too early" or "too late" may for the individual patient be a difficult judgment but the benefits of making this correct clinical judgment is now undoubted. Liver replacement for advanced liver disease can no longer be considered an experimental undertaking now that so many of the technical issues have been resolved. Inevitably as in so many aspects of medicine the discussion will now concentrate on the timing of intervention rather than whether intervention itself should occur.