title: Liver Transplantation for Patients with Cholestatic Liver Diseases.
abstract: BACKGROUND
  Cholestatic liver diseases (CD) account for 11% of all liver transplantations (LT) in the Eurotransplant region. Despite the excellent long-term outcome that is considerably superior to all other indications for LT, transplant surgeons and physicians face nowadays - in the era of MELD (Model of End-Stage Liver Disease)-based allocation, organ shortage, and extended allocation policies - more and more challenges in this patient cohort, especially since there is no curative medical treatment for these entities.
  
  
  METHODS
  Based on a literature review and personal experience in liver transplantation for CD, we show the status quo of indication, allocation, and outcome as well as potential strategies to overcome long waiting times and organ shortage.
  
  
  RESULTS
  Concerning graft and patient survival, CD remain the 'best indications' for LT. Since the implementation of MELD-based allocation results in patients with primary sclerosing cholangitis (PSC) could be preserved on good levels only by the implementation and revision of standard exceptions. Recurrence of PSC after LT remains a challenge for transplant surgeons and physicians. New data has kindled a debate on biliary reconstruction in LT for PSC. Promising data on living donor LT motivate to push the boundaries in this direction.
  
  
  CONCLUSIONS
  CD are excellent indications for liver transplantation since excellent long-term outcomes are achievable when the transplant is performed at the right time. The decisions concerning evaluation, listing, and allocation should be made by an interdisciplinary team of gastroenterologists and transplant surgeons.
authors.affiliation: General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Wenzel
authors.initials: W
authors.lastname: Schöning
authors.affiliation: General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Schmeding
authors.affiliation: General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Ulmer
authors.affiliation: General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Andert
authors.affiliation: General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Neumann
keywords: Cholestatic liver disease; Liver transplantation; Primary biliary cirrhosis; Primary sclerosing cholangitis