Liver Transplantation in an Era of Organ Shortage
Results of liver transplantation (LTx) have largely improved over the last few years. One-year patient survival of approximately 90% for elective LTx can now be achieved in centers that specialize in the treatment of liver disease. The successes we have witnessed are the consequence of several factors: better patient selection and preoperative preparation, improved surgical techniques, improved intra- and postoperative care, reduced incidence of primary nonfunction of graft and hepatic artery thrombosis (both ≤ 5%), the understanding that the liver induces a tolerogenic response, and the development of more judicious immunosuppressive protocols. LTx, however, has become a victim of its own success. An increasing number of patients are referred for LTx, but the number of available grafts has remained stagnant at best. The organ shortage is the only limiting factor to further application of LTx. The aims of the Leuven meeting were to: analyze the extent of this problem in Europe, discuss the difficult topic of allocation of a scarce resource, and study surgical strategies to increase the number of available liver grafts and medical alternatives to support patients with liver failure until a liver graft becomes available.