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Review
. 2011 Sep;11(9):1773-84.
doi: 10.1111/j.1600-6143.2011.03587.x. Epub 2011 Jun 14.

Major challenges limiting liver transplantation in the United States

J A Wertheim  1 , H Petrowsky, S Saab, J W Kupiec-Weglinski, R W Busuttil
Affiliations
Review

Major challenges limiting liver transplantation in the United States

J A Wertheim et al. Am J Transplant. 2011 Sep.

Abstract

Liver transplantation is the gold standard of care in patients with end-stage liver disease and those with tumors of hepatic origin in the setting of liver dysfunction. From 1988 to 2009, liver transplantation in the United States grew 3.7-fold from 1713 to 6320 transplants annually. The expansion of liver transplantation is chiefly driven by scientific breakthroughs that have extended patient and graft survival well beyond those expected 50 years ago. The success of liver transplantation is now its primary obstacle, as the pool of donor livers fails to keep pace with the growing number of patients added to the national liver transplant waiting list. This review focuses on three major challenges facing liver transplantation in the United States and discusses new areas of investigation that address each issue: (1) the need for an expanded number of useable donor organs, (2) the need for improved therapies to treat recurrent hepatitis C after transplantation and (3) the need for improved detection, risk stratification based upon tumor biology and molecular inhibitors to combat hepatocellular carcinoma.

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Conflict of interest statement

Disclosures:

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1
Figure 1. Gap between supply and demand for useable donor livers
Annual number of listed liver transplant candidates at the end of the year (solid circle) are compared to the total liver transplantations (open triangle) performed in the United States since the introduction of the MELD allocation system. Data were retrieved from the 2009 OPTN/SRTR Annual Report (94).
Figure 2
Figure 2. Distribution of liver transplantations performed in the United States in 2008 according to type of donor organ
DBD, donation after brain death; DCD, donation after cardiac death; LDLT, living donor liver transplantation. Data were retrieved from the 2009 OPTN/SRTR Annual Report (94).
Figure 3
Figure 3. Distribution of alternative liver grafts (donation after cardiac death, living donor split grafts and split grafts from brain dead donors) between 1999 and 2008
Annual number of liver transplantations performed with partial grafts from living donors (open triangle), split grafts from brain death donors (open circle), and full grafts from donation after cardiac death (solid circle). The total number of this pool is represented by the open square. Data were retrieved from the 2009 OPTN/SRTR Annual Report (94).
Figure 4
Figure 4. Factors associated with recurrent hepatitis C disease after liver transplantation
See this image and copyright information in PMC

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