Liver transplantation: an update.
OBJECTIVE
Recent attention in liver transplantation has focused on equity in organ allocation and management of post-transplant complications.


RESULTS
Adoption of the model for end-stage liver disease (MELD) for liver allocation has been successful in implementing a system based on medical urgency rather than waiting time. Refinements are being studied in reducing geographic disparities and improving transplant benefit by balancing pre-transplant mortality and post-transplant survival. With hepatocellular carcinoma becoming a bigger proportion of liver transplants since MELD, emerging literature is examining expansion of the current criteria for transplantation of hepatocellular carcinoma. Hepatitis C virus infection is associated with worse patient and graft survival post-transplantation than other liver diseases. The optimal timing and delivery of current antiviral therapy and immunosuppressive strategies in reducing the severity of hepatitis C virus recurrence post-transplantation are discussed. Chronic renal dysfunction after liver transplantation is a source of considerable morbidity. Nephron-sparing immunosuppression regimens are emerging with encouraging results.


CONCLUSIONS
Organ allocation tends to evolve under MELD with a focus on reducing geographic disparities and maximizing transplant benefit. Hepatitis C virus, hepatocellular carcinoma and chronic renal dysfunction are a major challenge and continued research in these areas will undoubtedly lead to better outcomes for transplant recipients.
Section of Gastroenterology and Hepatology, University of Wisconsin-Madison, School of Medicine and Public Health, 53792, USA. axs@medicine.wisc.edu
Adnan
A
Said
Michael R
MR
Lucey
D006801:Humans; D007165:Immunosuppression Therapy; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000517:prevention & control; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects; D012720:Severity of Illness Index; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D014850:Waiting Lists