Skip to main content

Advertisement

SpringerLink
Log in

Liver transplantation: current and future

  • Special Section: Liver Transplantation
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this paper is to summarize the allocation challenges facing the field of liver transplantation while providing examples of the expansion of indications for the procedure.

Methods

UNOS allocation policy was reviewed as well as the recent literature describing expanded criteria for recipient candidate selection.

Results

Liver allocation policy changes for deceased-donor organs remain gridlocked in legal and bureaucratic red tape. Meanwhile, the indications for liver transplantation are being expanded to include acute alcoholic hepatitis, intrahepatic cholangiocarcinoma, and colorectal metastasis, previously viewed as absolute contraindications, but under strict selection criteria.

Conclusions

Attempting to meet the demand for livers, transplant centers are increasingly turning to living donor liver transplantation, protocols such as HCV-positive to HCV-negative transplants, and machine perfusion of marginal organs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. OPTN Database. http://optn.transplant.hrsa.gov. 2019.

  2. Hughes CB (2015) The history of trying to fix liver allocation: Why a consensus approach will never work. Clin Transplant 29(6):477-483. https://doi.org/10.1111/ctr.12550

  3. Shulman M. (2013) Case 1:18-cv-06371, Cruz v HHS. 29181United States Dist Court South Dist New. 53(9):1-49.

  4. Canfield P, Bunting-Graden J (2019) Case 1:19-cv-01783AT. United States Dist Court North Dist Georg Atlanta Div:1-93.

  5. Luthi S (2019) Judge agrees to delay liver disribution policy again. Natl Coalit Transpl Equity.;May 16:1-2.

  6. Carey E, Lai J, Sonnenday C, et al. (2019) A North American Expert Opinion Statement on Sarcopenia in Liver Transplantation. Hepatology.0:1-14. doi: https://doi.org/10.1002/hep.30828

  7. Carey EJ, Lai JC, Wang CW, et al. (2017) A multicenter study to define sarcopenia in patients with end-stage liver disease. Liver Transplant.;23(5):625-633. https://doi.org/10.1002/lt.24750

  8. Masuda T, Shirabe K, Ikegami T, et al. (2014) Sarcopenia is a prognostic factor in living donor liver transplantation. Liver Transplant 20(4):401-407. https://doi.org/10.1002/lt.23811

  9. Parrish NF, Feurer ID, Matsuoka LK, Rega SA, Perri R, Alexopoulos SP. (2019) The Changing Face of Liver Transplantation in the United States: The Effect of HCV Antiviral Eras on Transplantation Trends and Outcomes. Transplant Direct 5(3):1-7. https://doi.org/10.1097/txd.0000000000000866

  10. Selzner N, Berenguer M. (2018) Should organs from hepatitis C-positive donors be used in hepatitis C-negative recipients for liver transplantation? Liver Transplant 24(6):831-840.

  11. Bari K, Luckett K, Kaiser T, et al. (2018) Hepatitis C transmission from seropositive, nonviremic donors to non–hepatitis C liver transplant recipients. Hepatology 67(5):1673-1682.

  12. Orman E, Maria M, Wheeler S, et al. (2015) Declining Liver Graft Quality Threatens the Future of Liver Transplantation in the United States. Liver Transplant 13:1040-1050.

  13. Mathurin P, Moreno C, Samuel D, et al. (2011) Early liver transplantation for severe alcoholic hepatitis. N Engl J Med 365(19):1790-1800. https://doi.org/10.1056/nejmoa1105703

  14. Dominguez M, Rincón D, Abraldes JG, et al. (2008) A new scoring system for prognostic stratification of patients with alcoholic hepatitis. Am J Gastroenterol 103(11):2747-2756. https://doi.org/10.1111/j.1572-0241.2008.02104.x

  15. Im GY, Kim-Schluger L, Shenoy A, et al. (2016) Early Liver Transplantation for Severe Alcoholic Hepatitis in the United States - A Single-Center Experience. Am J Transplant 16(3):841-849. https://doi.org/10.1111/ajt.13586

  16. Lee BP, Chen PH, Haugen C, et al. (2017) Three-year results of a pilot program in early liver transplantation for severe alcoholic hepatitis. Ann Surg 265(1):20-29. https://doi.org/10.1097/sla.0000000000001831

  17. Gores GJ, Nagorney DM, Rosen CB (2017) Cholangiocarcinoma: Is transplantation an option? For whom? J Hepatol 47(4):456-459. https://doi.org/10.1016/j.jhep.2007.07.002

  18. Sudan D, Deroover A, Chinnakotla S, et al. (2002) Radiochemotherapy and Transplantation Allow Long-Term Survival For Nonresectable Hilar Cholangiocarcinoma. Am J Transplant 2:774-779.

    Article  Google Scholar 

  19. Zamora-Valdes D, Heimbach JK (2018) Liver Transplant for Cholangiocarcinoma. Gastroenterol Clin North Am 47(2):267-280. https://doi.org/10.1016/j.gtc.2018.01.002

  20. Pascher A, Jonas S, Neuhaus P (2003) Intrahepatic cholangiocarcinoma: Indication for transplantation. J Hepatobiliary Pancreat Surg 10(4):282-287. https://doi.org/10.1007/s00534-002-0731-9

  21. Lunsford KE, Javle M, Heyne K, et al. (2018) Liver transplantation for locally advanced intrahepatic cholangiocarcinoma treated with neoadjuvant therapy: a prospective case-series. Lancet Gastroenterol Hepatol 3(5):337-348. https://doi.org/10.1016/s2468-1253(18)30045-1

  22. Mazzaferro V, Pulvirenti A, Coppa J (2007) Neuroendocrine tumors metastatic to the liver: How to select patients for liver transplantation? J Hepatol 47(4):460-466. https://doi.org/10.1016/j.jhep.2007.07.004

  23. Simmonds P, Primrose J, Colquitt J, Garden O, Poston G, Rees M (2006) Surgical resection of hepatic mets from colorectal cancer: A systematic review of published studies British J Cancer 94:982-999. https://doi.org/10.1038/sj.bjc.6603033

  24. Mentha G, Majno P, Terraz S, et al (2007)Treatment strategies for the management of advanced colorectal liver metastases detected synchronously with the primary tumour. Eur J Surg Oncol 33(SUPPL. 2):76-83. https://doi.org/10.1016/j.ejso.2007.09.016

  25. McCarter M, Fong Y (2000) Metastatic liver tumors. Semin Surg Oncol 19(2):177-188.

    Article  CAS  Google Scholar 

  26. Hagness M, Foss A, Line P-D, et al (2013) Liver transplantation for nonresectable liver metastases from colorectal cancer. Ann Surg 257(5):800-806. https://doi.org/10.1097/sla.0b013e3182823957

  27. Fung JJ, Eghstad B, Patel-Tom K (2007) Using livers from Donation After Cardiac Death Donors–A Proposal to Protect the True Achilles Heel. Liver Transplant 13(5):1633-1636.

  28. Schlegel A, Dutkowski P (2018) Impact of Machine Perfusion on Biliary Complications after Liver Transplantation. Int J Mol Sci 19(11). https://doi.org/10.3390/ijms19113567

  29. Humar A, Ganesh S, Jorgensen D, et al (2019) Adult Living Donor Versus Deceased Donor Liver Transplant (LDLT Versus DDLT) at a Single Center. Ann Surg 270(3):444-451. https://doi.org/10.1097/sla.0000000000003463

Download references

Acknowledgements

This work was supported in part by Health Resources and Services Administration Contract 234-2005-37011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations that imply endorsement by the US Government.

Author information

Authors and Affiliations

  1. Starzl Transplantation Institute, University of Pittsburgh Medical Center, 3459 Fifth Avenue, MUH N725, Pittsburgh, PA, 15213, USA

    Christopher B. Hughes & Abhinav Humar

Authors
  1. Christopher B. Hughes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Abhinav Humar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christopher B. Hughes.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hughes, C.B., Humar, A. Liver transplantation: current and future. Abdom Radiol 46, 2–8 (2021). https://doi.org/10.1007/s00261-019-02357-w

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-019-02357-w

Keywords

Search

Navigation