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2016 ; 22
(18
): 4438-45
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Liver transplantation: Current status and challenges
#MMPMID27182155
Jadlowiec CC
; Taner T
World J Gastroenterol
2016[May]; 22
(18
): 4438-45
PMID27182155
show ga
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.
|Allografts
[MESH]
|Animals
[MESH]
|Donor Selection
[MESH]
|Graft Rejection/immunology/prevention & control
[MESH]
|Graft Survival/drug effects
[MESH]
|Humans
[MESH]
|Immunosuppressive Agents/adverse effects/*therapeutic use
[MESH]
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