الفهرس 
Liver Transplantation ”an OverviewOnly 14 pages are availabe for public view
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Abstract
Background: Despite major advances in the medical management of liver disease with increasingly effective therapies, most notably in chronic viral hepatitis, most patients who have decompensated cirrhosis, unresectable hepatocellular carcinoma, or fulminant hepatic failure have no prospect of long-term survival short of liver transplantation. Liver transplantation underwent a period of maturation fueled by significant advances in the surgical techniques of liver transplantation, improvements in immunosuppressive drug regimens to manage rejection, and implementation of effective strategies to prevent post-transplantation infections, all of which have led to further improvement in outcomes during the subsequent 20 years Aim of the work: To clarify the role of liver transplantation in management of end stage liver disease caused by viral hepatitis as regard types, indications, contraindications, pre-operative precautions and management of postoperative complications related to viral disease specially recurrence. Overview: Orthotopic liver transplantation (OLT) has become a well-established modality for treatment of previously fatal liver disease. Remarkable progress has been made in the last two decades since the first OLT was performed in 1963. The five major indications for liver transplantation include ALF, hepatic decompensation secondary to chronic liver disease, primary hepatic malignancies, inborn errors of metabolism (metabolic disorders), and miscellaneous causes. Contraindications to liver transplantation include poor compliance, lack of an adequate support system, and clinical conditions associated with poor post-transplantation outcome. Brain death and metastatic cancer are obvious absolute contraindications to liver transplantation. Some contraindications are absolute, whereas others are relative and vary from one transplantation center to another. Acute Liver Failure: Liver transplantation appropriately is considered to have revolutionized the management of acute or fulminant liver failure. The overall success rates of liver transplantation are in the main satisfactory, although these generally are not as high as for elective transplantation. Although the bulk of liver transplants use standard whole grafts, interesting data are emerging, particularly with respect to auxiliary liver grafts and donations from living donors. HBV: Once decompensation occurs in patients with HBV-related cirrhosis, orthotopic liver transplantation (OLT) should be considered. Although antiviral therapy such as lamivudine has been shown to stabilize or improve liver disease, clinical improvement is slow and may not be of help to patients with very advanced liver failure HCV: Since liver transplantation (LT) was approved as a life-saving intervention for end-stage liver disease in 1983, decompensated cirrhosis from hepatitis C virus (HCV) has become the leading indication for LT in the United States. Over the past decade several studies have reported that short- and long-term outcomes of LT for HCV are poorer compared with LT for non HCV-related diseases, including patients transplanted for hepatocellular carcinoma. This is in large part owing to the universal recurrence of HCV as well as synergistic cofactors that influence disease progression Conclusions: Despite the results of liver transplantation due to end stage liver disease caused by viral disease are inferior to other causes, liver transplantation should still be considered the treatment of choice for these patients. Efforts should be increased to prevent viral recurrence by preoperative and postoperative therapies.