Update on liver transplantation: indications, organ allocation, and long-term care

Liver transplantation (LT) is definitive treatment for patients with acute liver failure and end- stage liver disease and in a subset of primary hepatic malignancies. For patients who successfully undergo LT, the probability of long-term graft and recipient survival is generally excellent, with a high likelihood of return to a relatively normal lifestyle. This article will review current indications, contraindications and postoperative care in LT. With the number of potential recipients far exceeding the number of deceased donor organs, new strategies are being explored to increase access to LT, including: splitting cadaveric donor livers, the use of living donors, and the adoption of the Model for End-Stage Liver Disease (MELD) scoring system, which is based on a mathematical formula to stratify patients in greatest need of transplantation. The allocation of deceased donor organs will, however, remain a contentious issue unless the donor pool is greatly expanded.