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VOLUME 5 , ISSUE 2 ( July-December, 2015 ) > List of Articles


Liver Transplantation Update: 2014

Ahmet Gurakar, Serkan Dogan

Citation Information : Gurakar A, Dogan S. Liver Transplantation Update: 2014. Euroasian J Hepatogastroenterol 2015; 5 (2):98-106.

DOI: 10.5005/jp-journals-10018-1144

License: CC BY-NC 4.0

Published Online: 01-06-2017

Copyright Statement:  Copyright © 2015; The Author(s).


The first liver transplantation (LT) was performed by Thomas E Starzl five decades ago, and yet it remains the only therapeutic option offering gold standard treatment for end-stage liver disease (ESLD) and acute liver failure (ALF) and certain early-stage liver tumors. Post-liver transplantation survival has also dramatically improved over the last few decades despite increasing donor and recipient age and more frequent use of marginal organs to overcome the organ shortage. Currently, the overall 1 year survival following LT in the United States is reported as 85 to 90%, while the 10 years survival rate is ~50% ( The improvements are mainly due to progress in surgical techniques, postoperative intensive care, and the advent of new immunosuppressive agents. There are a number of factors that influence the outcomes prior to transplantation. Since 2002, the model for end-stage liver disease (MELD) score has been considered a predicting variable. It has been used to prioritize patients on the transplant waiting list and is currently the standard method used to assess severity in all etiologies of cirrhosis. Hepatocellular carcinoma (HCC) is the most common standard MELD exception because the MELD does not necessarily reflect the medical urgency of patients with HCC. The criteria for candidates with HCC for receiving LT have evolved over the past decade. Now, patients with HCC who do not meet the traditional Milan (MC) or UCSF criteria for LT often undergo downstaging therapy I an effort to shrink the tumor size. The shortage of donor organs is a universal problem. In some countries, the development of a deceased organ donation program has been prevented due to socioeconomic, cultural, legal and other factors. Due to the shortage of cadaveric donors, several innovative techniques have been developed to expand the organ donor pool, such as split liver grafts, marginal- or extended-criteria donors, live donor liver transplantation (LDLT), and the use of organs donated after cardiac death. Herein, we briefly summarize recent advances in knowledge related to LT. We also report common causes of death after liver transplant, including the recurrence of hepatitis C virus (HCV) and its management, and coronary artery disease (CAD), including the role of the cardiac calcium score in identifying occult CAD.

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  1. Freeman RB Jr, Wiesner RH, Harper A, McDiarmid SV, Lake J, Edwards E, Merion R, Wolfe R, Turcotte J, Teperman L; UNOS/OPTN Liver Disease Severity Score, UNOS/OPTN Liver and Intestine, and UNOS/OPTN Pediatric Transplantation Committees. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl 2002;8(9):851-858
  2. Liver transplantation for hepatocellular carcinoma: impact of the MELD allocation system and predictors of survival. Gastroenterol 2008;134(5):1342-1351
  3. Liver transplant waiting time does not correlate with waiting list mortality: implications for liver allocation policy. Liver Transpl 2000;6(5):543-552
  4. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatol 2000;31:864e71
  5. Advanced liver disease study group. The model for end-stage liver disease (MELD). Hepatol 2007; 45(3):797-805
  6. MELD score, allocation, and distribution in the United States. Clin Liver Dis 2013; 2:148-151
  7. D-MELD, a simple predictor of post liver transplant mortality for optimization of donor/recipient matching. Am J Transpl 2009;9(2):318-326
  8. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med 2008 Sep 4;359(10):1018-1026
  9. A revised model for end-stage liver disease optimizes prediction of mortality among patients awaiting liver transplantation. Gastroenterol 2011;140(7):1952-1960
  10. Perioperative risk predictors of cardiac outcomes in patients undergoing liver transplantation surgery. Circulation 2009;120(13):1189-1194
  11. Multivessel coronary artery disease predicts mortality, length of stay, and pressor requirements after liver transplantation. Liver Transpl 2010;16(11):1242-1248
  12. Malik, Stuart D, et al. Role of cardiac calcium score in identifying occult coronary artery disease, among patients undergoing liver transplant work up. 64th Annual Meeting of the American Association for the Study of Liver Diseases
  13. GLOBOCAN 2000: cancer incidence, mortality and prevalence worldwide, version 1.0. International Agency for Research on Cancer Cancer Base no. 5. Lyon, France: IARC Press, 2001
  14. GLOBOCAN 2008. (Available at: http:// 15. Yang HI, Sherman M, Su J, Chen PJ, Liaw YF, Iloeje UH, Chen CJ. Nomograms for risk of hepatocellular carcinoma in patients with chronic hepatitis B virus infection. J Clin Oncol 2010;28(14):2437-2444
  15. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996;334(11):693-699
  16. Management of hepatocellular carcinoma. Hepatol 2005;42(5):1208-1236
  17. Management of hepatocellular carcinoma: an update. Hepatol 2011;53(3):1020-1022
  18. Resection of hepatocellular cancer ≤2 cm: results from two western centers. Hepatol 2013;57(4):1226-1235
  19. Radiofrequency ablation versus hepatic resection for the treatment of hepatocellular carcinomas 2 cm or smaller: a retrospective comparative study. Radiol 2012;262(3):1022-1033
  20. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice? Hepatol 2008;47(1):82-89
  21. Milan criteria in liver transplantation for HCC: an evidence-based analysis on 15 years of experience. Liver Transpl 2011;17(Suppl 2):S44-57
  22. Multimodal treatment of hepatocellular carcinoma on cirrhosis: an update. World J Gastroenterol 2013;19(42):7316-7326
  23. Role of the multidisciplinary team in the diagnosis and treatment of hepatocellular carcinoma. Expert Rev Gastroenterol Hepatol 2012;6(2):173-185
  24. Hepatocellular carcinoma. N Engl J Med 2011;365(12):1118-1127
  25. The diagnostic and economic impact of contrast imaging techniques in the diagnosis of small hepatocellular carcinoma in cirrhosis. Gut 2010;59(5):638-644.
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