Managing Access to Liver Transplantation: Implications for Gastroenterology Practice

Abstract

Among the challenges in liver transplantation, the limits of patient access to transplantation continue to drive a broad range of research and innovation. In contrast, continued improvements in immunosuppression over the past decade have dramatically reduced the consequences of rejection such that recurrent disease, in particular HCV and HCC, and comorbid conditions are now the largest threat to the long-term survival of transplant recipients. Scarcity of organs has sharpened the impetus to select for transplantation those patients who are most likely to benefit from the transplant and least likely to be harmed by the process. The MELD has assisted physicians in prognosticating and choosing the most appropriate candidates for transplantation. LDLT necessitates a distinct workup from deceased donor liver transplantation and requires unique consideration of timing of the transplantation. Recurrent HCV and optimal management of patients with HCC continue to challenge transplant hepatologists and gastroenterologists caring for transplant candidates and recipients. © 2007 AGA Institute.