[Indications and contraindications for liver transplantation]

Area of Science:

• Hepatology
• Transplantation Medicine
• Gastroenterology

Background:

• Liver transplantation (LT) has transitioned from an experimental procedure to a standard therapy for various end-stage liver diseases.
• Key consensus conferences, such as the 1983 Washington Conference, have defined indications for LT.
• Major transplant centers perform a significant volume of liver transplantations annually.

Purpose of the Study:

• To review the current indications and evolving landscape of liver transplantation.
• To discuss the impact of new therapeutic approaches on LT decision-making.
• To highlight specific conditions where LT remains a primary treatment option.

Main Methods:

• Review of established clinical guidelines and consensus statements on LT indications.
• Analysis of recent trends and shifts in LT practice.
• Discussion of therapeutic advancements influencing LT candidacy.

Main Results:

• LT is increasingly being avoided in cases of extensive primary liver cancer.
• Conservative treatments like ursodeoxycholic acid have delayed LT indications for primary biliary cirrhosis.
• LT remains the unambiguous choice for fulminant and subfulminant liver failure.
• Hepatitis C-related cirrhosis is a significant consideration, while hepatitis B cirrhosis has a better prognosis with antiviral therapy.
• LT is a first-line therapy for specific conditions including Wilson's disease, alpha-1-antitrypsin deficiency, and alveolar echinococcosis.

Conclusions:

• The indications for liver transplantation are dynamic, influenced by advancements in medical and surgical therapies.
• While LT is indispensable for acute liver failure, its application in other conditions is subject to ongoing re-evaluation.
• LT continues to be a vital, and sometimes primary, therapeutic option for a range of rare and severe liver diseases.