Recent advances in liver transplantation

Abstract

Liver transplant is a life-saving treatment with 1-year and 5-year survival rates of 90% and 70%, respectively. However, organ demand continues to exceed supply, such that many patients will die waiting for an available organ. This article reviews for the general gastroenterologist the latest developments in the field to reduce waiting list mortality and maximise utilisation of available organs. The main areas covered include legislative changes in organ donation and the new 'opt-out' systems being rolled out in the UK, normothermic machine perfusion to optimise marginal grafts, a new national allocation system to maximise benefit from each organ and developments in patient 'prehabilitation' before listing. Current areas of research interest, such as immunosuppression withdrawal, are also summarised.

Keywords: liver transplantation.

Figure 1

Change in number of donors, liver transplant (LT) and number of patients awaiting LT over a 10-year period (data obtained from NHSBT annual report 2019/2020). NHSBT, NHS Blood and Transplant.

Figure 2

The OrganOx metra normothermic liver perfusion device.

Figure 3

Calculation of the transplant benefit score for national allocation of donation after brainstem death (DBD) organs throughout the UK. Livers are offered nationally to named adult elective patients predicted to gain the most survival benefit (orange area on the graph) from receiving the particular liver graft on offer. A total of 21 recipient and 7 donor factors are included in the score. (Figure reproduced with permission from the NHSBT website).