New Developments and Challenges in Liver Transplantation

Abstract

Liver disease is increasing in incidence and is the third most common cause of premature death in the United Kingdom and fourth in the United States. Liver disease accounts for 2 million deaths globally each year. Three-quarters of patients with liver disease are diagnosed at a late stage, with liver transplantation as the only definitive treatment. Thomas E. Starzl performed the first human liver transplant 60 years ago. It has since become an established treatment for end-stage liver disease, both acute and chronic, including metabolic diseases and primary and, at present piloting, secondary liver cancer. Advances in surgical and anaesthetic techniques, refined indications and contra-indications to transplantation, improved donor selection, immunosuppression and prognostic scoring have allowed the outcomes of liver transplantation to improve year on year. However, there are many limitations to liver transplantation. This review describes the milestones that have occurred in the development of liver transplantation, the current limitations and the ongoing research aimed at overcoming these challenges.

Keywords: cell therapy; ex vivo perfusion; hepatocyte transplant; history; limitations; liver transplantation; nonalcoholic fatty liver disease; organ preservation; regenerative medicine; transplant oncology.

Figure 1

Liver transplant milestones. Abbreviations: DCD—Cardiac death; DAA—Direct-acting antiviral agent.