Surgical Liver Transplant

Cirrhosis is a chronic liver disease that is characterized by destruction of the functional liver cells, which leads to cellular death. Cirrhosis along with other chronic liver diseases result in up to 35,000 deaths each year in the United States and is the ninth leading cause of death. In cirrhosis, the damaged liver cells regenerate as fibrotic areas instead of functional cells, causing alterations in liver structure, function, blood circulation, and lymph damage. The major cellular changes include irreversible chronic injury of the functional liver tissue and the formation of regenerative nodules. These changes result in liver cell necrosis, collapse of liver support networks, distortion of the vascular bed, and nodular regeneration of the remaining liver cells.

The classification of cirrhosis is controversial at present. However, most types may be classified by a mixture of causes and cellular changes, defined as follows: alcoholic; crypto-genic and postviral or postnecrotic; biliary; cardiac; metabolic, inherited, and drug-related;

234 Cirrhosis and miscellaneous. The first three types are the most commonly seen, accounting for 55% to 90% of cases of cirrhosis. Although each of these types has a different etiology, the clinical findings, including portal vein hypertension and eventual liver failure, are much the same (Box 2).

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