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C OMPLICATIONS are common after liver transplantation. A decade ago, the University of Pittsburgh reported that 87% of patients experienced severe complications] This high rate of complications is not surprising because end-stage liver disease, independent of transplantation, is accompanied by multiple, severe secondary end-organ dysfunction. These include systemic vascular dilatation, hepatorenal and hepatopulmonary syndromes, and encephalopathy. These secondary complications are often the primary reason for liver transplantation, because a functioning liver graft leads to resolution of these multiorgan abnormalities. In this respect, the major "complications" of liver transplantation are, in fact, the resolution of end-organ dysfunction. For this reason, we review the basic physiology of end-stage liver disease and what is known of its resolution after liver transplantation. In addition, complications strictly attributable to the transplant procedure, specifically venovenous bypass complications and hepatic artery thrombosis, also are reviewed.

Summary Lung transplantation is an evolving technology. It is amazing how much has changed in just a few years as new information has become available. Information in this article will probably also become outdated quickly. Nevertheless, this report does represent the generally accepted current views regarding candidate selection and choice of transplant procedure. The trend over the years has been to broaden indications and liberalize criteria. However, the era of managed care is upon us and this is forcing us to closely examine costs. The greater emphasis placed on cost will probably negatively impact further liberalization of selection criteria. To remain competitive in the managed care era, centers will be rewarded for performing procedures as cheaply as possible. One way to accomplish this is to avoid high-risk patients and high-risk procedures. A high-risk procedure can be defined as anything that has never been performed or has been performed only a few times. Because pushing forward the frontiers of knowledge requires assumption of greater risks of complications and/or adverse outcomes with the attendant risk of higher costs and poorer outcome, the current environment is not conducive to innovation in lung transplantation. A revisit of this topic in the next 4 or 5 years should be interesting.