Liver transplantation: Current status and challenges

Caroline C. Jadlowiec, Timucin Taner

Research output: Contribution to journalArticle

54 Scopus citations

Abstract

Great progress has been made in the field of liver transplantation over the past two decades. This progress, however, also brings up the next set of challenges: First, organ shortage remains a major limitation, and accounts for a large proportion of wait list mortality. While living donation has successfully increased the total number of liver transplants done in Asian countries, the total number of such transplants has been stagnant in the western hemisphere. As such, there has been a significant effort over the past decade to increase the existing deceased donor pool. This effort has resulted in a greater use of liver allografts following donation after cardiac death (DCD) along with marginal and extended criteria donors. Improved understanding of the pathophysiology of liver allografts procured after circulatory arrest has not only resulted in better selection and management of DCD donors, but has also helped in the development of mechanical perfusion strategies. Early outcomes demonstrating the clinical applicability of both hypothermic and normothermic perfusion and its potential to impact patient survival and allograft function have generated much interest. Second, long-term outcomes of liver transplant recipients have not improved significantly, as recipients continue to succumb to complications of long-term immunosuppression, such as infection, malignancy and renal failure. Furthermore, recent evidence suggests that chronic immune-mediated injury to the liver may also impact graft function.

Original languageEnglish (US)
Pages (from-to)4438-4445
Number of pages8
JournalWorld Journal of Gastroenterology
Volume22
Issue number18
DOIs
StatePublished - May 14 2016

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Keywords

  • Antibodymediated rejection
  • Donation after cardiac death
  • Mechanical perfusion
  • Renal-sparing immunosuppression

ASJC Scopus subject areas

  • Gastroenterology

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