Liver Transplantation Today: Where We Are Now and Where We Are Going

Abstract

Liver transplantation was made a reality through the bravery, innovation, and persistence of Dr. Thomas Starzl. His death in 2017, at the age of 90, makes us pause to consider how far the field has come since its inception by this remarkable pioneer. It also is an opportunity to evaluate the continued novel innovations which contribute to the growth and potential for liver transplantation in the future. The liver transplant community in 2017 continued to be most significantly challenged by an overwhelming disparity between the need for liver transplant and the shortage of donor organs. The many ways in which this critical shortage are being addressed are examined in this article. The continued debate about equitable and efficacious organ allocation, "the liver wars," has dominated much of the recent past, while efforts to optimize current organ availability have also been aggressively pursued. Efforts to optimize the use of marginal and expanded criteria organs have escalated in recent years and have been accompanied by rigorous scientific evaluation. The ongoing opioid epidemic, combined with the approval and availability of highly effective hepatitis C treatment options, has allowed the increased use of HCV positive organs in HCV positive and negative recipients. Machine perfusion, both cold and warm, has moved solidly into the liver transplant world potentiating optimization of marginal donors and also offering potential modulation of liver grafts (ie, gene therapy, stem cell therapy, and defatting). Finally, pharmacological and mechanical interventions in DCD procurement techniques have contributed to improved outcomes in DCD transplants. All of these are explored in this article as a tribute to innovative spirit of Dr. Starzl and his continued impact on liver transplant today.

Iron overload as a risk factor for hepatic ischemia-reperfusion injury in liver transplantation: Potential role of ferroptosis

“…The shortage of transplant organs has been a worldwide problem in solid organ transplantation for decades, and as a result, many candidates who need to undergo transplantation do not have an opportunity to be transplanted. One strategy to solve this problem is expansion of the donor pool by using marginal donors including donation after circulatory death or organs with diseases such as nonalcoholic fatty liver disease or hepatitis virus . However, marginal grafts are particularly susceptible to I/R injury and may lead to early graft dysfunction and primary nonfunction.…”

Temporal trends in utilization and outcomes of steatotic donor livers in the United States

“…As of 2017, there were >13 000 candidates on the liver transplant waitlist, but only 8082 liver transplants were performed . In order to minimize this imbalance between supply and demand, there have been efforts to expand the donor pool by using marginal donor organs, 1 example of which is the steatotic donor liver (SDL) . As many as 25% of donors for liver transplantation have some degree of hepatic steatosis .…”

Induction of liver transplant immune tolerance in an outbred rat strain model using tacrolimus Subtitle: Therapeutic effect of tacrolimus in rat orthotopic liver transplantation models

“…As the number of patients with liver disease increases, the frequency of liver transplantation (LT), which is the nal treatment method, is increasing. LT is the treatment of choice for end-stage liver disease and acute liver failure, based on overall survival and quality of life [1,2]. The success of LT and long-term survival depend on the use of immunosuppressant drugs.…”