Liver transplantation: an update

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Abstract

Purpose of review

Recent attention in liver transplantation has focused on equity in organ allocation and management of post-transplant complications.

Recent findings

Adoption of the model for end-stage liver disease (MELD) for liver allocation has been successful in implementing a system based on medical urgency rather than waiting time. Refinements are being studied in reducing geographic disparities and improving transplant benefit by balancing pre-transplant mortality and post-transplant survival. With hepatocellular carcinoma becoming a bigger proportion of liver transplants since MELD, emerging literature is examining expansion of the current criteria for transplantation of hepatocellular carcinoma. Hepatitis C virus infection is associated with worse patient and graft survival post-transplantation than other liver diseases. The optimal timing and delivery of current antiviral therapy and immunosuppressive strategies in reducing the severity of hepatitis C virus recurrence post-transplantation are discussed. Chronic renal dysfunction after liver transplantation is a source of considerable morbidity. Nephron-sparing immunosuppression regimens are emerging with encouraging results.

Summary

Organ allocation tends to evolve under MELD with a focus on reducing geographic disparities and maximizing transplant benefit. Hepatitis C virus, hepatocellular carcinoma and chronic renal dysfunction are a major challenge and continued research in these areas will undoubtedly lead to better outcomes for transplant recipients.

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