title: Liver transplantation in the context of organ shortage: toward extension and restriction of indications considering recent clinical data and ethical framework.
abstract: OBJECTIVE
  The scarcity of liver grafts requires to optimize the results of transplantation. Extensions and alternatives of liver transplantation have to be regularly evaluated.
  
  
  RESULTS
  Acute-on-chronic liver failure and severe alcoholic hepatitis may represent potential extensions of transplant indications. In these diseases, selected patients could obtain a significant benefit from liver transplantation, whereas long-term outcomes and global impact on waiting lists remain to be evaluated prospectively. Alternatives to transplantation may be represented by recent progress in the management of hepatitis C and the treatment of hepatocellular carcinoma. In hepatitis C, new drug combinations may improve the disease control, reducing the progression to cirrhosis and also the risk of post-transplant reinfection allowing to anticipate a future decrease in the indications for transplantation and retransplantation in these patients. In hepatocellular carcinoma, thanks to improvements in operative techniques and better identification of prognostic factors of cancer recurrency, surgical resection or radiofrequency destruction could appear now as true alternatives to transplant in highly selected patients.
  
  
  CONCLUSIONS
  Before implementation of these potential changes into decisional algorithms for listing and organ allocation, their consequences, either for patient's individual benefit or for global transplant outcomes, should be closely evaluated using objective long-term end points and taking into account the ethical recommendations for organ transplantation.
authors.affiliation: aLiver Transplant Unit, Department of Abdominal Surgery, Université Libre de Bruxelles (ULB) bLiver Transplant Unit, Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
authors.forename: Valerio
authors.initials: V
authors.lastname: Lucidi
authors.forename: Thierry
authors.initials: T
authors.lastname: Gustot
authors.forename: Christophe
authors.initials: C
authors.lastname: Moreno
authors.forename: Vincent
authors.initials: V
authors.lastname: Donckier
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000601:surgery*; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000628:therapy; D006519:Hepatitis, Alcoholic / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000941:ethics* / Q000379:methods; D018579:Patient Selection / Q000941:ethics; D012307:Risk Factors; D012720:Severity of Illness Index; D014019:Tissue Donors / Q000600:supply & distribution; D009927:Tissue and Organ Procurement / Q000941:ethics*; D014850:Waiting Lists