**Section 3**

**Transplantation, Cell Therapies and Liver Bioengineering** 

174 Liver Regeneration

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**10** 

**Liver Transplantation in the Clinic –** 

Marco Carbone1, Giuseppe Orlando2,3, Brian Sanders4,

Antonio Famulari6, Jan P. Lerut5 and Francesco Pisani6,\*

Christopher Booth2, Tom Soker2, Quirino Lai5, Katia Clemente6,

**Progress Made During the Last Three Decades** 

The World Health Organization calculates that over – six hundred and fifty million people worldwide suffer of some form of liver disease, including thirty million Americans. On a worldwide base, approximately one to two million deaths are accounted to liver related diseases annually. Around the globe, China has the world's largest population of Hepatitis B patients (approx. 120 million) with five hundred thousand people dying of liver illnesses every year (CDC, 2007; WHO, 2008). In the US alone, five hundred thousand critical liver problem episodes are reported every year requiring hospitalization with great burden to the patients and a huge cost to the health care system. In the European Union and United States of America alone, over eighty one thousand and twenty six thousand people died of chronic liver disease in 2006, respectively (CDC, 2007; Eurostat, 2007). In these patients, liver transplantation is presently the only proven therapy able to extend survival for end-stage liver disease. It is also the only treatment for severe acute liver failure and to some forms of

The road to successful liver grafting in humans has been long and fraught with many obstacles. Experimental attempts at liver transplantation originally took place in the 1950s and 1960s, but human liver transplantation did not become a reality until 1963 (Starzl & Demetris, 1990). Although unsuccessful, Dr. Starzl's attempt at liver transplantation was a milestone in surgery. However, it took nearly 20 years to develop a surgical procedure for orthotopic liver transplantation (OLT) that was safe to apply in humans. In 1983, the National Institutes of Health (NIH) held the Consensus Development Conference on Liver Transplantation. The most important outcome of this conference was OLT became an accepted therapeutic modality for some patients with end-stage liver disease (NIH, 1983). The ideal liver transplant candidate needed to comply with ten conditions (**Table 1**) as well

**1. Introduction** 

inborn errors of metabolism.

\* *1Hepatology Unit, Addenbrooke's Hospital, Cambridge, UK* 

*2 Wake Forest Institute for Regenerative Medicine, Winston Salem, NC, USA* 

*6Renal Failure and Transplant Unit – L'Aquila University, L'Aquila, Italy* 

*3 Department of General Surgery, Wake Forest Baptist Health, Winston Salem, NC, USA 4 Wake Forest University School of Medicine, Winston Salem, USA* 

*5 Starzl Abdominal Transplant Unit, University Hospitals St.Luc, Université Catholique de Louvain, Brussels,* 

*Belgium* 
