The evolution of the liver transplant candidate

Abstract

The first successful human liver transplant (LT) was done over 60 years ago; since the early pioneering days, this procedure has become a routine treatment with excellent outcomes for the great majority of recipients. Over the last six decades, indications have evolved. Use of LT for hepatic malignancy is becoming less common as factors that define a successful outcome are being increasingly defined, and alternative therapeutic options become available. Both Hepatitis B and C virus associated liver disease are becoming less common indications as medical treatments become more effective in preventing end-stage disease. Currently, the most common indications are alcohol-related liver disease and metabolic associated liver disease. The developing (and controversial) indications include acute on chronic liver failure, alcoholic hepatitis and some rarer malignancies such as non-resectable colorectal cancer liver metastases, neuroendocrine tumours and cholangiocarcinoma. Candidates are becoming older and with greater comorbidities, A relative shortage of donor organs remains the greatest cause for reducing access to LT; therefore, various countries have developed transparent approaches to allocation of this life saving and life enhancing resource. Reliance on prognostic models has gone some way to improve transparency and increase equity of access but these approaches have their limitations.

Outcomes of liver transplant in patients with alcohol use disorders and opioid use disorders

“…Interestingly, the data over the last 2 decades has argued otherwise, and patients with SUDs are now increasingly being considered for transplant. In the 2000s, hepatitis C was the leading indication for LT. Today, alcohol-associated liver disease (ALD) is the leading indication [1,2] This paper will review the LT outcomes for patients with alcohol use disorder (AUD) and opioid use disorder (OUD).There has been robust data over the last 2 decades demonstrating that rates of survival, adherence, and acute rejection are generally comparable between patients who receive LT for ALD and for non alcoholassociated liver disease. In a 2018 review, Rogal et al found that survival rates posttransplant were comparable and sometimes even better in patients with ALD compared to patients receiving transplants for viral or autoimmune illnesses.…”

“…Interestingly, the data over the last 2 decades has argued otherwise, and patients with SUDs are now increasingly being considered for transplant. In the 2000s, hepatitis C was the leading indication for LT. Today, alcohol-associated liver disease (ALD) is the leading indication [1,2] This paper will review the LT outcomes for patients with alcohol use disorder (AUD) and opioid use disorder (OUD).…”