Liver Transplantation 2023: Status Report, Current and Future Challenges

Abstract

Liver transplantation has seen significant changes in the past decade, including the expanding use of MELD-based models to prioritize organs (ie, MELD 3.0), the changing indications (reduction of viral-related indications and increase of metabolic-related or cancer-related indications), the changing phenotype of transplant candidates and donors (older, higher frequency of comorbidities, particularly metabolic syndrome, increasing disease severity, and sarcopenia/frailty). Despite increasing complexities, post-transplant outcomes remain good and strategies continue to evolve to reduce surgical complications through enhanced recovery after transplantation programs,179Dueland S. Foss A. Solheim J.M. et al.Survival following liver transplantation for liver-only colorectal metastases compared with hepatocellular carcinoma.Br J Surg. 2018; 105: 736-742Crossref PubMed Scopus (46) Google Scholar minimally invasive donor hepatectomy (laparoscopic or robotic surgery),180Hernandez-Alejandro R. Ruffolo L.I. Sasaki K. et al.Recipient and donor outcomes after living-donor liver transplant for unresectable colorectal liver metastases.JAMA Surg. 2022; 157: 524-530Crossref PubMed Scopus (21) Google Scholar and donor pool expansion through the safer use of donation after circulatory death in the context of machine perfusion.