Liver transplantation: current status and future prospects.

Area of Science:

• Hepatology
• Transplantation immunology
• Surgical innovation

Background:

• Liver transplantation has seen remarkable advancements, achieving nearly 90% survival at 12 months.
• Increased success and broader indications for liver transplantation have led to a critical shortage of donor organs.
• This donor scarcity results in patients developing advanced disease, rendering them unsuitable for transplantation by the time a liver becomes available.

Purpose of the Study:

• To address the critical shortage of donor livers for transplantation.
• To explore immediate strategies for managing the gap between organ demand and supply.
• To review emerging alternative therapies for liver failure.

Main Methods:

• Analysis of current trends in liver transplantation outcomes and donor organ availability.
• Evaluation of strategies to manage patient waiting lists and optimize organ allocation.
• Review of preclinical and experimental alternative liver support and replacement technologies.

Main Results:

• High survival rates post-liver transplantation are contrasted by a significant donor organ deficit.
• The current options are limited to reducing patient waiting lists or increasing living donor liver transplantation.
• Alternative approaches like hepatocyte transplantation, gene therapy, xenotransplantation, and bioartificial livers are under development but not yet clinically viable.

Conclusions:

• The success of liver transplantation is challenged by organ donor shortages, creating a critical unmet need.
• Urgent strategies are required to manage the disparity between patients needing transplants and available organs.
• Future medical therapies may prevent or cure liver diseases, potentially reducing the future need for transplantation.