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Gastroenterology. 2015 Feb;148(2):307-23. doi: 10.1053/j.gastro.2014.08.045. Epub 2014 Sep 16.

Challenges to liver transplantation and strategies to improve outcomes.

Author information

1
Swiss HPB and Transplantation Center, Departments of Surgery and Medicine, University Hospital Zurich, Zurich, Switzerland.
2
Swiss HPB and Transplantation Center, Departments of Surgery and Medicine, University Hospital Zurich, Zurich, Switzerland. Electronic address: clavien@access.uzh.ch.

Abstract

Liver transplantation (LT) is a highly successful treatment for many patients with nonmalignant and malignant liver diseases. However, there is a worldwide shortage of available organs; many patients deteriorate or die while on waiting lists. We review the important clinical challenges to LT and the best use of the scarce organs. We focus on changes in indications for LT and discuss scoring systems to best match donors with recipients and optimize outcomes, particularly for the sickest patients. We also cover controversial guidelines for the use of LT in patients with hepatocellular carcinoma and cholangiocarcinoma. Strategies to increase the number of functional donor organs involve techniques to perfuse the organs before implantation. Partial LT (living donor and split liver transplantation) techniques might help to overcome organ shortages, and we discuss small-for-size syndrome. Many new developments could increase the success of this procedure, which is already one of the major achievements in medicine during the second part of the 20th century.

KEYWORDS:

Cholabgiocarcinoma; HCC; Hepatitis C; Liver Transplantation; Machine Perfusion

PMID:
25224524
DOI:
10.1053/j.gastro.2014.08.045
[Indexed for MEDLINE]

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