title: Update on the management of the liver transplant patient.
abstract: OBJECTIVE
  To review and highlight recent literature regarding the medical management of adult patients undergoing liver transplantation.
  
  
  RESULTS
  The addition of serum sodium concentration to the model for end-stage liver disease (MELD) score more accurately predicts 90-day waitlist mortality. Predictors of waitlist mortality and posttransplant survival include lower albumin and the presence of ascites, varices, and encephalopathy, as well as more nontraditional predictors such as older age, obesity, frailty, and sarcopenia. Indications for liver transplantation are evolving with the advent of effective therapy for hepatitis C and the increased prevalence of nonalcoholic steatohepatitis. Disparities persist in the current allocation system, including geographic variation and MELD inflation for hepatocellular carcinoma. Share 35 allows for broader regional sharing of organs for patients with the highest need, without detrimental effects on waitlist mortality or survival. Everolimus is a recently approved option for posttransplant immunosuppression that spares renal function.
  
  
  CONCLUSIONS
  The MELD score has enabled the liver transplant community to equitably allocate organs. Recent literature has focused on the limitations of the MELD score and the disparities inherent in the current system. The next steps for liver transplantation will be to develop strategies to further optimize waitlist prioritization and organ allocation.
authors.affiliation: aDepartment of Medicine, University of California, San Francisco, California bOrgan Transplant Department, Swedish Medical Center, Seattle, Washington, USA.
authors.forename: Allison J
authors.initials: AJ
authors.lastname: Kwong
authors.forename: Oren K
authors.initials: OK
authors.lastname: Fix
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000097:blood* / Q000401:mortality; D015897:Comorbidity; D058625:End Stage Liver Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D000068338:Everolimus / Q000008:administration & dosage; D016330:Frail Elderly / Q000706:statistics & numerical data; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016031:Liver Transplantation / Q000379:methods; D008875:Middle Aged; D009765:Obesity / Q000401:mortality; D018579:Patient Selection; D011379:Prognosis; D055948:Sarcopenia / Q000401:mortality; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood*; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods*; D014850:Waiting Lists / Q000401:mortality
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D012964:Sodium