LIVER TRANSPLANTATION 1089-3261/97 $0.00 zy + .20 SELECTION OF PATIENTS FOR LIVER TRANSPLANTATION IN 1997 AND BEYOND Eric M. Yoshida MD, and John R. Lake MD Within the past three decades, liver transplantation has evolved from its "experimental" infancy, with a demoralizingly high periopera- tive mortality," to the "cyclosporine era" of the early 1980~,~' by which time, the technical aspects of surgery had been overcome and cyclo- sporine dramatically improved patient and graft survival. In the 1990s, tacrolimus (FK506) produced further improvement in rates of graft rejectionz3, 84 and graft survival. As the turn of the century approaches, newer immunosuppressive agents, such as mycophenolate mofetil (RS 61443),62 will undoubtedly have an impact on liver transplantation. Mir- roring the favorable evolutionary history of liver transplantation has been the increasing number of transplant centers and the increasing number of transplants in both the United States and Canada. For the year ending 1993, in the United States, 94 centers performed 3411 trans- plants (mean 36.3; median 21) versus 58 centers that transplanted 1713 livers in 198Ei5 North of the border, in 1991, seven Canadian centers performed 177 liver transplant^.^^ Liver transplantation is now accepted as the standard surgical- medical treatment for end-stage liver disease as well as replacement therapy for certain inborn errors of metabolism. Indications for liver transplantation continue to change with new developments in medical- surgical science and this current review differs in certain areas from the last comprehensive review.3y What remains constant, however, is the From the British Columbia Transplant Society and the Department of Medicine, the University of British Columbia, Vancouver, BC, Canada (EMY) and the University zy of California, San Francisco (JRL) CLINICS IN LIVER DISEASE VOLUME 1 * NUMBER 2 * AUGUST 1997 zyxwvu 247