Journal
GASTROENTEROLOGY
Volume 148, Issue 2, Pages 307-323Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.gastro.2014.08.045
Keywords
Liver Transplantation; HCC; Cholabgiocarcinoma; Machine Perfusion; Hepatitis C
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Funding
- Swiss National Science Foundation [32003B-109906, 32003B-140776/1]
- Clinical Research Priority Program of the University of Zurich
- Swiss National Science Foundation (SNF) [32003B_140776] Funding Source: Swiss National Science Foundation (SNF)
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Liver transplantation (LT) is a highly successful treatment for many patients with nonmalignant and malignant liver diseases. However, there is a worldwide shortage of available organs; many patients deteriorate or die while on waiting lists. We review the important clinical challenges to LT and the best use of the scarce organs. We focus on changes in indications for LT and discuss scoring systems to best match donors with recipients and optimize outcomes, particularly for the sickest patients. We also cover controversial guidelines for the use of LT in patients with hepatocellular carcinoma and cholangiocarcinoma. Strategies to increase the number of functional donor organs involve techniques to perfuse the organs before implantation. Partial LT (living donor and split liver transplantation) techniques might help to overcome organ shortages, and we discuss small-for-size syndrome. Many new developments could increase the success of this procedure, which is already one of the major achievements in medicine during the second part of the 20th century.
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