Liver transplantation: an update 2008

Purpose of review Expansion of the donor pool for liver transplantation is a priority. Management of hepatitis C and hepatocellular carcinoma has focused on decreasing recurrence rates after transplantation. Recent findings Expansion of the pool of donors has focused on live donor liver transplantation and extended criteria donor grafts. The results of live donor liver transplantation are equivalent to those of deceased donor liver transplantation. The use of extended criteria donor grafts has increased significantly. The results are associated with decreased graft survival with the use of grafts that have multiple factors considered as extended criteria for transplantation, particularly in high-risk individuals such as critically ill recipients. Judicious matching of extended criteria donors with recipients is essential to reduce waiting list mortality without reducing posttransplantation survival. The role of pretransplant ablation therapy for hepatocellular carcinoma is evolving to reduce tumor progression and dropout on the list as well as to influence posttransplant recurrence rates. Antiviral and immunosuppressive strategies in reducing the severity of hepatitis C virus recurrence are discussed as is retransplantation for the disease. Summary Expansion of the donor pool with the use of extended criteria donors and live donor liver transplantation is a major challenge. Transplantation for hepatocellular carcinoma and hepatitis C virus relapse are major areas of research.