Update on liver transplantation-newer aspects

Area of Science:

• Hepatology
• Transplantation immunology
• Gastroenterology

Background:

• Liver transplantation (LT) is the gold standard for end-stage liver disease (ESLD), acute liver failure (ALF), and early liver tumors.
• A critical shortage of donor livers limits LT, driving the need for expanded donor criteria and marginal grafts.

Purpose of the Study:

• To address the organ shortage in liver transplantation.
• To evaluate the use of marginal liver grafts and early LT for severe alcoholic hepatitis (SAH).

Main Methods:

• Review of current challenges in liver transplantation, including donor pool limitations.
• Analysis of the role and definition of marginal liver grafts (e.g., steatotic, older donors, DCD).
• Examination of outcomes for early LT in SAH patients, questioning the traditional 6-month abstinence rule.

Main Results:

• Marginal liver grafts, including those from older donors or donation after cardiac death (DCD), are increasingly utilized.
• Early LT for severe alcoholic hepatitis (SAH) demonstrates satisfactory initial results, challenging conventional waiting periods.

Conclusions:

• Expanding the use of marginal liver grafts is essential to overcome donor organ scarcity.
• Early LT for selected SAH patients may offer a life-saving option, necessitating a re-evaluation of traditional eligibility criteria.