Transplant Interventions

Andrew J. Lipnik, MD

Jeet Minocha, MD

Liver disease is both broad in scope and global in impact, resulting in nearly 2 million global deaths annually. Although recent advancements in treatment of Hepatitis C will decrease the impact of this chronic infection, increasing rates of nonalcoholic fatty liver disease are expected to increase the overall incidence of chronic liver disease in the future. Coincident increasing rates of hepatocellular carcinoma are expected to make it the third leading cause of cancer death worldwide by 2030. First performed by Thomas Starzl in 1963, liver transplantation remains the definitive treatment for chronic liver disease and liver failure. Although advancements in medical management and surgical techniques have pushed 1- and 5-year survival beyond 90 and 75%, respectively, organ scarcity remains a significant problem, with 12,992 patients currently waiting for a liver transplant in the United States alone. Maximization of this scarce resource requires thoughtful allocation, patient preparation, and graft maintenance through a truly multidisciplinary approach including hepatologists, transplant surgeons, interventional gastroenterologists, and interventional radiologists. In this issue of Digestive Disease Interventions, we provide up-to-date reviews of patient selection and preparation prior to transplantation, medical management following transplant, and minimally invasive treatment strategies for posttransplant vascular and biliary complications. Our hope is to highlight the multidisciplinary approach that is critical to the successful management of these complex patients.