The Need to Update Endpoints and Outcome Analysis in the Rapidly Changing Field of Liver Transplantation

Abstract

Liver transplantation (LT) survival rates have continued to improve over the last decades, mostly due to the reduction of mortality early after transplantation. The advancement is facilitating a liberalization of access to LT, with more patients with higher risk profiles being added to the waiting list. At the same time, the persisting organ shortage fosters strategies to rescue organs of high-risk donors. This is facilitated by novel technologies such as machine perfusion. Owing to these developments, reconsideration of the current and emerging endpoints for the assessment of the efficacy of existing and new therapies is warranted. While conventional early endpoints in LT have focused on the damage induced to the parenchyma, the fate of the bile duct and the recurrence of the underlying disease have a stronger impact on the long-term outcome. In light of this evolving landscape, we here attempt to reflect on the appropriateness of the currently used endpoints in the field of LT trials.

Immune cell dynamics deconvoluted by single-cell RNA sequencing in normothermic machine perfusion of the liver

“…Liver transplantation (LT) is the sole definitive treatment for end-stage liver disease 1 – 3 . Organ shortage remains a major limiting factor with the demand far exceeding supply.…”

Using Period Analysis to Timely Assess and Predict 5-Year Relative Survival for Liver Cancer Patients From Taizhou, Eastern China

“…First, the calculation period was 8 years earlier for the report of 19.1% during 2005–2010 for Zhejiang province compared to our data (2014–2018). It is common sense that the survival of liver cancer patients shall be improved along with the progress of science and technology and the improvement of treatment over recent years (8 years later for our data) ( 12 – 16 ), as well as the implementation of early screening programs for liver cancer patients ( 17 – 20 ) and the accessibility of medical insurance systems for the local population. Second, the report of 19.1% for 2005–2010 was calculated by the cohort approach, which shall be significantly lower compared to the survival estimate calculated by the period approach, as confirmed by our group for the 5-year RS during 2009–2013 ( 9 ).…”

New Organ Transport Support Technology is a Game Changer

“…As the Innsbruck team creates strategies to rescue high‐risk organs, they are also shifting their focus from conventional endpoints. In liver transplantation, as an example, they are studying not only damage induced to the parenchyma but also the fate of bile ducts and the possibility of preventing recurrence of underlying disease 5 . They believe that such rehabilitation and treatment of suboptimal donor organs has the potential to transform transplantation.…”