Forty Years of Liver Transplantation in the United Kingdom-Reflections on Challenges and Achievements

In this contribution to the celebration of 40 years of liver transplantation in the United Kingdom, early successes and more often disappointments are recounted along with the many challenges that had to be overcome. Acceptance of brainstem criteria for death, formulation of the University of Wisconsin preservation solution, better understanding of the vasculature of the biliary tract, and the discovery of new immunosuppressive agents each in turn had an influence in improving survival. Realization that diseases could recur in the transplanted liver represented another major area of clinical documentation, and for the surgeons, there were the added challenges of double and triple transplants as well as liver splits and monosegment grafts in pediatric recipients.