title: Current challenges and future directions for liver transplantation.
abstract: Liver transplantation is an effective and widely used therapy for several patients with acute and chronic liver diseases. The discrepancy between the number of patients on the waiting list and available donors remains the key issue and is responsible for the high rate of waiting list mortality. The recent news is that the majority of patients with hepatitis C virus related liver disease will be cured by new antivirals therefore we should expect soon a reduction in the need of liver transplantation for these recipients. This review aims to highlight, in two different sections, the main open issues of liver transplantation concerning the current and future strategies to the best use of limited number of organs. The first section cover the strategies to increase the donor pool, discussing the use of older donors, split grafts, living donation and donation after cardiac death and mechanical perfusion systems to improve the preservation of organs before liver transplantation. Challenges in immunosuppressive therapy and operational tolerance induction will be evaluated as potential tools to increase the survival in liver transplant recipients and to reducing the need of re-transplantation. The second section is devoted to the evaluation of possible new indications to liver transplantation, where the availability of organs by implementing the strategies mentioned in the first section and the reduction in the number of waiting transplants for HCV disease is realized. Among these new potential indications for transplantation, the expansion of the Milan criteria for hepatocellular cancer is certainly the most open to question.
authors.affiliation: Department of Clinical Sciences Experimental and Clinical, Medical Liver Transplant Section, University of Udine, Udine, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Toniutto
authors.affiliation: Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padova, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zanetto
authors.affiliation: Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padova, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ferrarese
authors.affiliation: Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padova, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
mesh_terms: D000998:Antiviral Agents / Q000494:pharmacology; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007165:Immunosuppression Therapy; D017093:Liver Failure / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000639:trends*; D065626:Non-alcoholic Fatty Liver Disease / Q000601:surgery; D018579:Patient Selection; D012307:Risk Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000379:methods; D014850:Waiting Lists
chemical_list: D000998:Antiviral Agents
keywords: hepatocellular carcinoma; liver transplantation; machine perfusion; steatosis