Recent advances in liver transplantation

Russell H. Wiesner, Jorge Rakela, Michael B. Ishitani, David C. Mulligan, James R. Spivey, Jeffery L. Steers, Ruud A.F. Krom

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Abstract

Advances in liver transplantation continue to evolve but are hampered by continued increasing shortages in donor organs. This has resulted in a high incidence of patients dying while on the United Network for Organ Sharing waiting list. Indeed, we continue to assess ways of expanding the donor pool by using marginal donors, living donor liver transplantation, split liver transplantation, domino transplantation, and hepatic support systems to prolong survival long enough for the patient to undergo liver transplantation. Changes in the liver allocation policy to reduce the number of people dying while waiting for an organ are discussed. Implementation of the model for end-stage liver disease allocation system should help alleviate the problem of increasing deaths of patients while on the waiting list. Recurrent disease, particularly recurrent hepatitis C, continues to be a major problem, and effective therapy is needed to prevent both progression of hepatitis C and recurrence in the graft and avoid retransplantation. The use of pegylated interferon in combination with ribavirin holds promise for improving the success in overcoming recurrent hepatitis C. Finally, advances in immunosuppression have reduced the incidence of acute cellular rejection and chronic rejection. However, these therapies have been fraught with metabolic complications that are now affecting quality of life and long-term survival. Tailoring immunosuppressive regimens to the individual patient is discussed.

Original languageEnglish (US)
Pages (from-to)197-210
Number of pages14
JournalMayo Clinic proceedings
Volume78
Issue number2
DOIs
StatePublished - Feb 1 2003

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ASJC Scopus subject areas

  • Medicine(all)

Cite this

Wiesner, R. H., Rakela, J., Ishitani, M. B., Mulligan, D. C., Spivey, J. R., Steers, J. L., & Krom, R. A. F. (2003). Recent advances in liver transplantation. Mayo Clinic proceedings, 78(2), 197-210. https://doi.org/10.4065/78.2.197