5.12.6. Future developments

In most European countries, changes in alcohol drinking appear to well explain short-term changes in cirrhosis mortality at population level. Sudden variations in cirrhosis mortality are real and follow rapid changes in alcohol consumption in periods of political and socio-economic transformation.

Over the last few years, a contribution towards treatment and prognosis of cirrhosis has been provided by the introduction of liver transplantation.

The impact of the introduction of this procedure on cirrhosis mortality at national level in various European countries is however difficult to evaluate. In any case, it is likely to be modest to date due to its use mainly in very advanced and selected (i.e. comparatively younger) cases, the lack of population-based data on long-term prognosis after liver transplantation and the fact that the procedure has been only recently introduced on an appreciable scale,.

Furthermore,, in an appreciable – though again difficult to confidently quantify – proportion of cirrhosis cases, liver transplantation is performed after identification and diagnosis of liver cancer foci. Thus, at least part of the favourable impact of transplantation on chronic liver disease would be attributed to liver cancer following cirrhosis, rather than to cirrhosis itself.

A wider adoption of liver transplantation in the future is likely to increase its role in the treatment and prognosis of cirrhosis, but evaluation and quantification of any such role should be possible only in a few years time. Active monitoring of clinical practice in this field and, whenever possible, implementation of randomised trials, is advisable. (Schuppan D, Afdhal NH, 2008)