In 2023, we witnessed advances in allocation policies and marginal donors, including living donors. Key improvements included the uncapped Model for End-stage Liver Disease 3.0 score, unveiled machine perfusion trials to standard deceased donors and lessons from the aborted living donor liver transplantations.
Key advances
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With a rising number of liver transplant recipients with Model for End-stage Liver Disease (MELD) scores of 40 or higher, removing the cap on MELD scores might potentially offer increased survival benefits for those on the waitlist without jeopardizing post-transplant outcomes2.
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Although machine perfusion has substantially improved outcomes for extended criteria donors, current trials for standard donors have failed to demonstrate key advantages over the traditional static cold storage method and early allograft dysfunction after portable ex situ normothermic machine perfusion6, as well as 12-month patient survival rates.
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In the real world, aborted living donor liver transplantation had a 0.31% incidence among 13,937 patients, and this can be reduced by employing meticulous preoperative evaluations and embracing minimally invasive surgical techniques10.
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References
Kim, W. R. et al. MELD 3.0: the model for end-stage liver disease updated for the modern era. Gastroenterology 161, 1887–1895.e4 (2021).
Kim, W. R., Mannalithara, A., Kwo, P. Y., Bonham, C. A. & Kwong, A. Mortality in patients with end‐stage liver disease above model for end‐stage liver disease 3.0 of 40. Hepatology 77, 851–861 (2023).
Markmann, J. F. et al. Impact of portable normothermic blood-based machine perfusion on outcomes of liver transplant: the OCS liver PROTECT randomized clinical trial. JAMA Surg. 157, 189–198 (2022).
Ravaioli, M. et al. Hypothermic oxygenated perfusion in extended criteria donor liver transplantation-A randomized clinical trial. Am. J. Transpl. 22, 2401–2408 (2022).
Schlegel, A. et al. A multicenter randomized-controlled trial of hypothermic oxygenated perfusion (HOPE) for human liver grafts before transplantation. J. Hepatol. 78, 783–793 (2023).
Chapman, W. C. et al. Normothermic machine perfusion of donor livers for transplantation in the United States: a randomized controlled trial. Ann. Surg. 278, e912–e921 (2023).
Guo, Z. et al. A randomized-controlled trial of ischemia-free liver transplantation for end-stage liver disease. J. Hepatol. 79, 394–402 (2023).
Suh, K.-S. et al. Pure laparoscopic living donor liver transplantation: dreams come true. Am. J. Transpl. 22, 260–265 (2022).
Hong, S. K. et al. Long-term survival of 10,116 Korean live liver donors. Ann. Surg. 274, 375–382 (2021).
Toshima, T. et al. Aborted living-donor liver transplantation in the real-world setting, lessons from 13,937 cases of Vanguard Multi-center Study of International Living Donor Liver Transplantation Group. Am. J. Transplant. https://doi.org/10.1016/j.ajt.2023.07.011 (2023).
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Yi, NJ. See the reality again in the field of liver transplantation. Nat Rev Gastroenterol Hepatol 21, 74–75 (2024). https://doi.org/10.1038/s41575-023-00876-y
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DOI: https://doi.org/10.1038/s41575-023-00876-y
