Challenges in Expanding the Donor Pool and Improving Long-Term Outcomes for Liver Transplantation

Abstract

Liver transplantation is a curative treatment for many patients with end-stage liver disease, acute liver failure, and primary liver cancer when certain criteria are met. The persistent imbalance between organ availability and the number of patients on the waiting list presents both ethical and medical challenges in everyday clinical practice. Expanding the donor pool-and consequently increasing the number of retrieved grafts-requires action on multiple levels. These include raising awareness about organ donation, promoting willingness to donate, and increasing knowledge of post-transplant outcomes among the general population and healthcare professionals. In addition, organ acceptance criteria should be refined by incorporating recent advances in transplant hepatology and surgery. The survival benefit achieved through liver transplantation is well established for many conditions. To further improve long-term outcomes, more tailored and refined surveillance protocols are needed for the metabolic and neoplastic comorbidities that commonly develop after transplantation. In this updated literature review, we aim to highlight the main advances in these two crucial areas of liver transplantation.

Keywords: Acute-on-chronic liver failure; Fibrosis; Hepatocellular carcinoma; Machine perfusion; Outcome.