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Review
. 2024 Feb 28;60(3):412.
doi: 10.3390/medicina60030412.

Evolution of Liver Transplantation Indications: Expanding Horizons

Sara Battistella  1 , Marco Grasso  1 , Elisa Catanzaro  1 , Francesca D'Arcangelo  1 , Giorgia Corrà  1 , Giacomo Germani  1 , Marco Senzolo  1 , Alberto Zanetto  1 , Alberto Ferrarese  1 , Martina Gambato  1 , Patrizia Burra  1 , Francesco Paolo Russo  1
Affiliations
Review

Evolution of Liver Transplantation Indications: Expanding Horizons

Sara Battistella et al. Medicina (Kaunas). .

Abstract

Liver transplantation (LT) has significantly transformed the prognosis of patients with end-stage liver disease and hepatocellular carcinoma (HCC). The traditional epidemiology of liver diseases has undergone a remarkable shift in indications for LT, marked by a decline in viral hepatitis and an increase in metabolic dysfunction-associated steatotic liver disease (MASLD), along with expanded indications for HCC. Recent advancements in surgical techniques, organ preservation and post-transplant patients' management have opened new possibilities for LT. Conditions that were historically considered absolute contraindications have emerged as potential new indications, demonstrating promising results in terms of patient survival. While these expanding indications provide newfound hope, the ethical dilemma of organ scarcity persists. Addressing this requires careful consideration and international collaboration to ensure equitable access to LT. Multidisciplinary approaches and ongoing research efforts are crucial to navigate the evolving landscape of LT. This review aims to offer a current overview of the primary emerging indications for LT, focusing on acute-on-chronic liver failure (ACLF), acute alcoholic hepatitis (AH), intrahepatic and perihilar cholangiocarcinoma (i- and p-CCA), colorectal liver metastasis (CRLM), and neuroendocrine tumor (NET) liver metastases.

Keywords: NET metastases; acute alcoholic hepatitis; acute-on-chronic liver failure; cholangiocarcinoma; colorectal liver metastasis; hepatocellular carcinoma; liver transplantation.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Reported recurrence of alcohol disorder after LT [81,82,86,87,88].
Figure 2
Figure 2
Proposed algorithm for the management of unresectable colorectal liver metastasis. * Synchronous disease: liver-only CRL metastases diagnosed (radiologically or histologically) before/at time of primary colorectal cancer. ** Metachronous disease: liver-only CRL metastases diagnosed within a year or after 1 year of primary colorectal cancer diagnosis. *** Bridging therapy: systemic therapy administered to evaluate biological behavior of liver metastases after primary tumor resection.
See this image and copyright information in PMC

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