EASL Clinical Practice Guidelines

Introduction

The first human orthotopic liver transplantation (LT) in Europe was performed by Sir Roy Calne in Cambridge in 1968 [1], only one year after the first successful human liver transplantation reported by Thomas Starzl in the United States [2]. Since then LT has evolved rapidly, becoming the standard therapy for acute and chronic liver failure of all aetiologies, with more than 80,000 procedures performed to date. Survival rates have improved significantly in the last 25 years, achieving rates of 96% and 71% at 1 and 10 years after LT respectively [3].

This great success is mostly attributable to several advances such as the introduction of new immunosuppressive agents and preservation solutions, to the improvements in surgical techniques and to the early diagnosis and management of complications after LT [4]. As a consequence of these achievements, indications for LT have been expanded resulting in a growing demand for transplantable grafts and in a dramatic organ shortage. Therefore, one of the main ongoing challenges the transplant community is facing is to expand the donor pool in order to minimize the rate of patient death on the waiting list [5]. On the other hand, liver transplanted patients are surviving longer after the operation and long-term outcomes are becoming the main concern for clinicians, who have to deal with direct and indirect side effects of immunosuppressive therapy.

This Clinical Practice Guideline (CPG) has been developed to assist physicians and other healthcare providers during the evaluation process of candidates for LT and to help them in the correct management of patients after LT.

The evidence and recommendations in these guidelines have been graded according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) system [6]. The strength of recommendations reflects the quality of underlying evidence. The principles of the GRADE system have been enunciated. The GRADE system offers two grades of recommendation: strong (1) or weak (2) (Table 1). The CPGs thus consider the quality of evidence: the higher the quality of evidence, the more likely a strong recommendation is warranted; the greater the variability in values and preferences, or the greater the uncertainty, the more likely a weaker recommendation is warranted.

Table 1
GRADE system used in EASL Clinical Practice Guidelines [6].