Lesson learnt from 60 years of liver transplantation: Advancements, challenges, and future directions

Abstract

Over the past six decades, liver transplantation (LT) has evolved from an experimental procedure into a standardized and life-saving intervention, reshaping the landscape of organ transplantation. Driven by pioneering breakthroughs, technological advancements, and a deepened understanding of immunology, LT has seen remarkable progress. Some of the most notable breakthroughs in the field include advances in immunosuppression, a revised model for end-stage liver disease, and artificial intelligence (AI)-integrated imaging modalities serving diagnostic and therapeutic roles in LT, paired with ever-evolving technological advances. Additionally, the refinement of transplantation procedures, resulting in the introduction of alternative transplantation methods, such as living donor LT, split LT, and the use of marginal grafts, has addressed the challenge of organ shortage. Moreover, precision medicine, guiding personalized immunosuppressive strategies, has significantly improved patient and graft survival rates while addressing emergent issues, such as short-term complications and early allograft dysfunction, leading to a more refined strategy and enhanced post-operative recovery. Looking ahead, ongoing research explores regenerative medicine, diagnostic tools, and AI to optimize organ allocation and post-transplantation car. In summary, the past six decades have marked a transformative journey in LT with a commitment to advancing science, medicine, and patient-centered care, offering hope and extending life to individuals worldwide.

Keywords: Liver transplantation; Model for end-stage liver disease; Liver grafts allocation; Immunology and organ rejection; Types of liver transplantation techniques

Core Tip: Over the past 60 years, liver transplantation (LT) has become an effective and well-established curative intervention for patients presenting with acute and chronic liver failure. However, the cost, complexity, and shortage of donor organs for LT has greatly challenged this intervention. Nonetheless, modifications in patient selection criteria resulting in less stringent parameters for LT patient selection, the introduction of neoadjuvant therapies, and the rehabilitation of previously unsalvageable donors have had a significant impact in countering this challenge.