Transplant hepatology: New epidemiology and indications

Over the past decade, the field of liver transplantation (LT) has evolved remarkably, driven by advances in medical therapy, donor procurement, and candidate selection. The changing epidemiology of liver disease has reshaped the LT candidate profile, with increasing numbers of sicker, older, frailer, and more comorbid patients requiring multidisciplinary evaluation and tailored perioperative management. Robust assessment of post-LT outcomes has supported the expansion of transplant eligibility criteria to include patients with alcohol-related liver disease with abstinence of <6 months, severe alcohol-related hepatitis not responding to medical therapy, and hepatocellular carcinoma with higher tumour burden than conventional criteria. Moreover, selected patients with hepatic malignancies previously considered contraindications-such as colorectal cancer metastases and intrahepatic cholangiocarcinoma-appear to gain a survival benefit from LT and may soon represent accepted indications to be applied in many transplant programs worldwide. Simultaneously, surgical innovations, organ harvesting and preservation techniques and harmonized allocation systems have enhanced organ utilization and reduced waiting list mortality. Contemporary LT practice thus reflects a delicate balance between innovation and ethical responsibility. Remaining challenges include promoting equitable access, refining prognostic and psychosocial assessment tools, and adapting allocation frameworks to evolving patient populations. The future evolution of LT will depend on integrating technological progress, personalized care, and evidence-based selection to maximize survival benefit and societal value.