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Since Dr. Thomas Starzl performed the first series of successful liver transplants (LTs), important advances have been made in immunosuppression, operative techniques, and postoperative care. In 1988, Belzer’s group reported the first successful LT using the University of Wisconsin preservation solution (UW). Since then, UW has replaced EuroCollins solution and allowed prolonged and safer preservation of liver, kidney, and pancreas allografts, thus contributing to the improvement of transplant outcomes. Although UW is still considered the standard of care in the United States and in several countries worldwide, a recent meta-analysis revealed similar LT outcomes among UW, Celsior solution, and the Institut Georges Lopez-1 preservation solution, which were slightly superior to those obtained with histidine-tryptophan-ketoglutarate preservation solution. Dynamic preservation has been recently developed, and liver allografts are preserved mainly through the following methods: hypothermic machine perfusion, normothermic machine perfusion, and subnormothermic machine perfusion. Their use has the potential advantage of improving clinical results in LT involving extended criteria donor allografts. Although associated with increased costs, techniques employing machine perfusion of liver allografts have been considered clinically feasible. This editorial focuses on recent advances and future perspectives in liver allograft preservation.

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Background Esophageal achalasia is a precancerous condition for epidermoid carcinoma; prevalence and risk factors for cancer development are not defined. Aim of the study was to determine these parameters. Methods Achalasia patients observed in the period 1955-2016, since 1973 were periodically submitted to clinical assessment, barium swallow (esophageal diameter and residual barium column were measured), endoscopy, according to a prospective protocol. In this study we included patients with a minimum 12 months follow-up, endoscopy or radiology at the last control. Follow up was discontinued for decision or death of patients. Results Five hundred and eighty-three of 681 cases were considered. The median follow-up was 147.13 months (IQR 70.42-257.82 months); 17 epidermoid, 1 carcinosarcoma were diagnosed (30.8/1000 cases). At multivariate analysis esophageal diameter (p < 0.001), residual barium column (p < 0.05) and duration of dysphagia (p < 0.001) were independent risk factors. Conversely, the risk of epidermoid carcinoma development decreased after residual barium swallow decrease (p < 0.05), consequent to efficacious therapy. According to classification tree (Figure), patients with severe dysphagia at the last clinical-radiological control and sigmoid esophagus experienced a risk of epidermoid carcinoma development equal to 48.6%. classification tree for squamous cell carcinoma. o outcome; se sigmoid esophagus.jpg Conclusion End-stage achalasia and dysphagia lasting longer than 22 years are risk factors for development of epidermoid cancer. Effective Heller myotomy can interrupt the carcinogenetic process in the presence of end-stage achalasia. Patients who overcome the risk parameters, should be offered esophagectomy or conservative surgery followed by strict endoscopic surveillance. Disclosure All authors have declared no conflicts of interest.