Recent advances in adult liver transplantation have focused on medical rather than surgical aspects, particularly new immunosuppressive regimens using tacrolimus and the influence of patient selection on outcome. Compared with cyclosporine-based immunosuppression, tacrolimus has been associated with similar patient and graft survival, fewer rejection episodes, lower corticosteroid usage, and a lower incidence of infection; however, nephrotoxicity, neurotoxicity, and impairment of glucose metabolism are more frequent with tacrolimus. Excellent outcomes after liver transplantation for a number of genetic diseases and in patients with severe obesity and diabetes mellitus have been demonstrated. The poor results of liver transplantation for cholangiocarcinoma, even with aggressive chemotherapy and radiotherapy, have been confirmed. Pretransplant staging of hepatocellular carcinoma with imaging studies has been shown to have poor sensitivity for satellite lesions. Documentation of the influence of pretransplant selection criteria and long-term use of hepatitis B immune globulin on a favorable outcome of liver transplantation for hepatitis B virus infection has rekindled enthusiasm for transplantation of these patients. Finally, the debate regarding whether primary biliary cirrhosis or primary sclerosing cholangitis recur after liver transplantation continues.
