Long-term clinical outcome after liver transplantation

..................................................................................................... 6 Original publications.................................................................................. 8 Abbreviations............................................................................................. 9 Introduction.............................................................................................. 10 Review of the literature............................................................................ 12 LIVER TRANSPLANTATION ACTIVITY ................................................. 12 Indications .......................................................................................... 12 Contra-indications ............................................................................... 13 Organ donors ...................................................................................... 14 Organ allocation .................................................................................. 14 Surgical procedures ............................................................................. 15 IMMUNOSUPPRESSION......................................................................... 16 The immune response in liver transplantation ....................................... 16 Principles of immunotherapy................................................................ 18 Calcineurin inhibitors .......................................................................... 18 Corticosteroids .................................................................................... 20 Antimetabolites ................................................................................... 20 Mammalian target of rapamycin inhibitors ........................................... 21 Antibody therapies............................................................................... 21 Adverse effects of immunosuppression .................................................. 22 Clinical regimens and trends ................................................................ 24 OUTCOME AND SHORT-TERM COMPLICATIONS ................................. 26 Survival rates ...................................................................................... 26 Quality of life....................................................................................... 28 Employment ........................................................................................ 28 Short-term complications ..................................................................... 29 LONG-TERM COMPLICATIONS ............................................................. 31 Renal dysfunction ................................................................................ 31 Malignancy ......................................................................................... 32 Risk for cardiovascular disease ............................................................. 35 Other nonhepatic complications............................................................ 37 Hepatic complications .......................................................................... 37 Aims of the study ..................................................................................... 39 Patients and methods................................................................................ 40 PATIENTS AND GENERAL STUDY DESIGN........................................... 40 CLINICAL PARAMETERS AND DEFINITIONS........................................ 41 Renal function ..................................................................................... 42 Malignancies ....................................................................................... 42