[Liver transplantation - when and for whom it should be performed]

Area of Science:

• Hepatology and Transplant Surgery
• Medical Economics and Policy

Context:

• Orthotopic liver transplantation (OLT) is the standard treatment for end-stage liver disease.
• Switzerland faces a significant shortage of donor organs, with approximately 100 OLTs performed annually.
• Key indications for OLT include cirrhosis from alcohol or viral hepatitis (B/C) and hepatocellular carcinoma.

Purpose:

• To review the role of OLT in managing end-stage liver disease in Switzerland.
• To examine the impact of the Model for End-stage Liver Disease (MELD) score on organ allocation and patient management.
• To highlight the importance of timely evaluation and referral to transplant centers.

Summary:

• The MELD score, utilizing serum bilirubin, creatinine, and INR, predicts short-term mortality for liver transplant candidates.
• Since 2007, Switzerland's allocation policy uses MELD, leading to transplantation of sicker patients with higher MELD scores.
• While outcomes remain comparable, higher MELD scores correlate with increased complications and costs compared to the pre-MELD era.

Impact:

• The MELD system influences transplant decisions, potentially increasing post-transplant complications and healthcare costs.
• Timely referral and comprehensive evaluation are critical to identify contraindications and optimize patient selection for OLT.
• Patients with acute liver failure, decompensated cirrhosis, or suspected hepatocellular carcinoma require evaluation at specialized liver transplant centers.