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Liver Transplantation: Current Hurdles and Future Perspectives
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Liver Transplantation: Current Hurdles and Future Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: 20 August 2025 | Viewed by 1785

Special Issue Editor

Dr. Gabriele Spoletini

E-Mail Website
Guest Editor
1. General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
2. Medical and Surgical Sciences Department, Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
Interests: liver preservation; HCC; cirrhosis; liver transplant surgery; post-liver transplant care

Special Issue Information

Dear Colleagues,

Liver transplantation has evolved to produce excellent results over the decades, providing the ideal treatment for end-stage liver diseases and primary liver tumors. Recipient survival exceeds 90% and 75% at 1 and 5 years, respectively. The epidemiology of indications has changed too, with a broader space for neoplasms (expanded HCC criteria, intra- and extra-hepatic cholangiocarcinoma, NET, and unresectable colorectal liver metastases), increasing rates of metabolic-related cirrhosis, a declining incidence of virus-related chronic liver disease, and more frail, elderly, high-acuity recipients. At the same time, improvements in graft preservation strategies thanks to the widespread use of machine perfusion allowed the use of extended criteria grafts, with a growing role of donation after circulatory death of various types, attenuated ischemia/reperfusion injury, and extended preservation. Still, a number of challenges remain unsolved, and the gap between the growing demand for potential liver transplant candidates and the number of available grafts is far from being filled.

In this Special Issue, we seek to focus on the current hurdles and future perspectives of liver transplantation, embracing all aspects from organ donation and preservation to perioperative care up to life-long recipient management.

Dr. Gabriele Spoletini
Guest Editor

Manuscript Submission Information

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Keywords

  • machine perfusion
  • donation after circulatory death
  • liver preservation
  • living donation
  • acute-on-chronic liver failure
  • frailty
  • liver malignancies
  • surgical technique
  • liver transplant recipient care
  • immunosuppression

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Published Papers (2 papers)

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Research

15 pages, 734 KiB  
Article
Effect of Complex Venous Outflow Drainage Reconstruction on Postoperative Graft Function in Right-Lobe Living Donor Liver Transplantation
by Hakan Kilercik, Sami Akbulut, Ahmed Elsarawy, Sema Aktas, Utku Alkara and Sinasi Sevmis
J. Clin. Med. 2025, 14(6), 2005; https://doi.org/10.3390/jcm14062005 - 16 Mar 2025
Viewed by 481
Abstract
Background: Living donor liver transplantation (LDLT) is the predominant transplantation technique in regions with low rates of deceased donation. Right-lobe grafting is adopted in most clinical and radiological donor/recipient scenarios. Due to the considerable variations in right-lobe hepatic venous anatomy, many techniques [...] Read more.
Background: Living donor liver transplantation (LDLT) is the predominant transplantation technique in regions with low rates of deceased donation. Right-lobe grafting is adopted in most clinical and radiological donor/recipient scenarios. Due to the considerable variations in right-lobe hepatic venous anatomy, many techniques have been used over the years for the purpose of appropriate venous outflow reconstruction during the recipient procedure. In this paper, we present the technical details and consequences of a complex venous outflow reconstruction model (CORM) based on experience, and the long-term patency results obtained using the model. Methods: Data of patients with end-stage liver disease who underwent LDLT between 21 December 2017 and 29 November 2022 were prospectively collected and retrospectively reviewed. The nomenclature of CORM was assigned when three or more hepatic vein anastomoses were performed. Patients with CORM (CORM group; n = 69) were compared with non-CORM patients (non-CORM group; n = 130) in terms of demographic, pre- and postoperative clinical, and follow-up features. Results: Sixty-nine recipients had three or more separate outflow reconstructions (RHV, RIHV, and one or more anterior sectoral veins); these constituted the CORM group. The estimated graft volume of the CORM group was significantly lower than that of the non-CORM group (833 vs. 898; p = 0.022), and the mean GRWR was also significantly lower (1.1 vs. 1.2; p = 0.004). CORM cases showed longer anhepatic phases, as well as longer times for cold and warm ischemia, than non-CORM cases (63 vs. 51 min, 46 vs. 38 min, and 48 vs. 33 min, p < 0.001), though no difference was found with respect to total operative duration. There were no statistical differences between the two groups with respect to rates of in-hospital re-exploration, length of ICU stay, or length of total hospital stay. Graft survival rates at 1 year, 3 years, and 5 years were 88.1%, 83.3%, and 83.3%, respectively, in the CORM group, and 82.9%, 80.2%, and 70.6%, respectively, in the non-CORM group (p = 0.167). Conclusions: Performing three or more CORMs in right-lobe LDLT is not associated with inferior outcomes, either with regard to perioperative variables or to patient and graft outcomes. Right-lobe graft with complex venous anatomy from a living donor should not be a determinant factor for donor exclusion. Full article
(This article belongs to the Special Issue Liver Transplantation: Current Hurdles and Future Perspectives)
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7 pages, 368 KiB  
Article
The Outcomes of Liver Transplantation in Highly Dependent Incapacitated Patients with Intellectual and Developmental Disabilities
by Michal Skalski, Oskar Kornasiewicz, Joanna Raszeja-Wyszomirska, Agata Konieczka, Monika Mlynarczyk and Michal Grat
J. Clin. Med. 2024, 13(19), 5702; https://doi.org/10.3390/jcm13195702 - 25 Sep 2024
Viewed by 912
Abstract
Background/Objectives: Data regarding the outcomes of liver transplantation in disabled, highly dependent, and legally incapacitated adults are scarce, likely due to the infrequency of these procedures in such populations. Multicenter studies in adult transplant centers have shown that patients with coexisting intellectual and [...] Read more.
Background/Objectives: Data regarding the outcomes of liver transplantation in disabled, highly dependent, and legally incapacitated adults are scarce, likely due to the infrequency of these procedures in such populations. Multicenter studies in adult transplant centers have shown that patients with coexisting intellectual and developmental disabilities (IDDs) may be denied transplantation because of their expected low longevity and the complexities associated with managing post-transplant care. We examined the long-term patient and graft outcomes in highly dependent, incapacitated patients with IDDs who underwent elective transplantation for chronic liver disease. Methods: Six adult patients who underwent liver transplantation for primary biliary cholangitis (n = 2), hepatitis C cirrhosis (n = 2), Wilson’s disease (n = 1), and autoimmune hepatitis (n = 1) were included. The main causes of their disability were infantile cerebral palsy, myotonia, and Niemann–Pick disease. Results: Four of the six patients were women, with a median age of 26 (range: 23–36) years. Only one patient died during follow-up. Their 1- and 5-year survival rates were 100 and 75%, respectively, which were not statistically different from those of the general cohort of electively transplanted patients (95.8 and 90.1%, respectively) (p = 0.35). Conclusions: Adult patients who are highly dependent, disabled, or legally incapable should not be denied liver transplantation because of poor long-term survival rates. Physiological disorders and psychiatric comorbidities should not prevent patients from receiving life-saving surgeries due to poor postoperative compliance or low quality of life. Full article
(This article belongs to the Special Issue Liver Transplantation: Current Hurdles and Future Perspectives)
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