Current State and Future Possibilities in Liver Transplantation

Area of Science:

• Hepatology
• Transplant Surgery
• Organ Preservation

Background:

• Liver transplantation (LT) has become a standard treatment for end-stage liver disease and liver cancer.
• Changing indications for LT include decreased use for hepatitis B/C cirrhosis and increased use for non-alcoholic steatohepatitis (NASH), alcoholic liver disease, and hepatocellular carcinoma (HCC).
• Multidisciplinary cancer treatment now incorporates LT for non-HCC hepatobiliary malignancies.

Purpose of the Study:

• To review the current landscape of liver transplantation, including evolving indications, challenges, and emerging technologies.
• To discuss the impact of patient selection, organ allocation ('sickest first'), and donor organ shortages on LT outcomes.
• To highlight the potential of normothermic machine perfusion (NMP) in improving organ viability and outcomes.

Main Methods:

• Review of current trends in liver transplantation indications and outcomes.
• Analysis of the impact of patient acuity (MELD score) and donor organ quality on post-transplant survival.
• Discussion of novel organ preservation techniques, specifically normothermic machine perfusion (NMP).

Main Results:

• Five-year survival rates after LT are approximately 75-80%.
• The 'sickest first' allocation principle and donor organ shortages have increased morbidity and mortality.
• Normothermic machine perfusion (NMP) shows promise in reducing liver damage and assessing organ viability, potentially improving outcomes for extended preservation times.
• High MELD scores (>30) are associated with a significant decrease in survival rates (12-18%).

Conclusions:

• Despite advancements, liver transplantation faces challenges due to sicker recipients and limited donor organs.
• Normothermic machine perfusion (NMP) represents a promising technology for improving organ utilization and outcomes.
• Future research should prioritize organ allocation optimization, immunosuppression strategies, and expanding the donor pool to enhance successful LT rates.