title: Challenges to liver transplantation and strategies to improve outcomes.
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.
authors.affiliation: Swiss HPB and Transplantation Center, Departments of Surgery and Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Dutkowski
authors.affiliation: Swiss HPB and Transplantation Center, Departments of Surgery and Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Linecker
authors.affiliation: Swiss HPB and Transplantation Center, Departments of Surgery and Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: DeOliveira
authors.affiliation: Swiss HPB and Transplantation Center, Departments of Surgery and Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Müllhaupt
authors.affiliation: Swiss HPB and Transplantation Center, Departments of Surgery and Medicine, University Hospital Zurich, Zurich, Switzerland. Electronic address: clavien@access.uzh.ch.
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery; D018281:Cholangiocarcinoma / Q000601:surgery; D006526:Hepatitis C / Q000601:surgery; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D008115:Liver Regeneration; D016031:Liver Transplantation / Q000379:methods*; D065626:Non-alcoholic Fatty Liver Disease / Q000601:surgery; D010477:Perfusion
keywords: Cholabgiocarcinoma; HCC; Hepatitis C; Liver Transplantation; Machine Perfusion