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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2016; 22(18): 4438-4445
Published online May 14, 2016. doi: 10.3748/wjg.v22.i18.4438
Liver transplantation: Current status and challenges
Caroline C Jadlowiec, Timucin Taner
Caroline C Jadlowiec, Timucin Taner, William J. von Liebig Transplantation Center, Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Jadlowiec CC and Taner T contributed equally to the conception and design, writing of the article, and critical revision.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Timucin Taner, MD, PhD, William J. von Liebig Transplantation Center, Division of Transplant Surgery, Department of Surgery, Mayo Clinic, 200 Second Street South-west, Rochester, MN 55905, United States. taner.timucin@mayo.edu
Telephone: +1-507-2663117 Fax: +1-507-2669806
Received: February 17, 2016
Peer-review started: February 18, 2016
First decision: March 21, 2016
Revised: March 25, 2016
Accepted: April 7, 2016
Article in press: April 7, 2016
Published online: May 14, 2016
Processing time: 77 Days and 4.9 Hours
Abstract

Great progress has been made in the field of liver transplantation over the past two decades. This progress, however, also brings up the next set of challenges: First, organ shortage remains a major limitation, and accounts for a large proportion of wait list mortality. While living donation has successfully increased the total number of liver transplants done in Asian countries, the total number of such transplants has been stagnant in the western hemisphere. As such, there has been a significant effort over the past decade to increase the existing deceased donor pool. This effort has resulted in a greater use of liver allografts following donation after cardiac death (DCD) along with marginal and extended criteria donors. Improved understanding of the pathophysiology of liver allografts procured after circulatory arrest has not only resulted in better selection and management of DCD donors, but has also helped in the development of mechanical perfusion strategies. Early outcomes demonstrating the clinical applicability of both hypothermic and normothermic perfusion and its potential to impact patient survival and allograft function have generated much interest. Second, long-term outcomes of liver transplant recipients have not improved significantly, as recipients continue to succumb to complications of long-term immunosuppression, such as infection, malignancy and renal failure. Furthermore, recent evidence suggests that chronic immune-mediated injury to the liver may also impact graft function.

Keywords: Donation after cardiac death; Mechanical perfusion; Renal-sparing immunosuppression; Antibody-mediated rejection

Core tip: Organ shortage remains a major limitation in liver transplantation, and there has been a significant effort over the past decade to increase the existing deceased donor pool. Recent advances have included better selection and management of donors after circulatory arrest, application of hypothermic and normothermic perfusion, minimization of standard immunosuppression and use of new immunosuppressive medications. Additionally, there has been renewed emphasis and understanding of liver immunology and the impact of antibody-mediated rejection. Together, these advances have allowed for expansion of the donor pool with concurrent improved patient outcomes.