**5. Salvage mechanisms and bridges to transplant**

Although liver transplantation is life-saving for acute and chronic liver failure, the immunosuppressant medications necessary to prevent rejection and allow optimal graft function following transplant are frequently accompanied by adverse metabolic effects, nephrotoxicity, and susceptibility to potentially fatal infections. In addition, the demand for transplant greatly exceeds the supply of donor livers, and many patients either die while awaiting a donor or become too critically ill to qualify for transplant. The discrepancy in the supply and demand for organs, and the high pre-transplant mortality and posttransplant morbidity have generated interest in surgical techniques to avoid transplantation and chronic immunosuppression, and support systems to serve as a bridge to transplant or spontaneous recovery. Examples of these include auxiliary liver transplantation and liver assist devices.
