Liver Transplantation: Changing Indications and Changing Candidates

Indications for liver transplantation continue to evolve rapidly, with the number of transplant procedures and donor organs more than doubling in the last 20 years. Despite the increase in donors and transplantation, there is broad geographic disparity in access to liver transplantation. Effective therapies for hepatitis C virus (HCV) have resulted in deep, sustained declines in HCV-related cirrhosis as an indication, with simultaneous increases in the frequency of liver transplantation for metabolic dysfunction-associated steatohepatitis and alcohol-related liver disease, especially among patients with brief periods of sobriety. MELD score-based allocation policies do not serve all indications for liver transplantation equally.