Up-to-Date Research in Liver Transplantation

Dear Colleagues,

Liver transplantation (LT) is a life-saving therapy for many acute or chronic liver diseases that cannot be cured with alternative therapies. Survival after transplantation has progressively increased in recent years due to the improved surgical and anesthesiologic techniques and the better clinical management in the pre- and post-transplant phases. However, the management of cardio-metabolic complications still needs to be improved, as they remain the most frequent causes of long-term mortality.

The epidemiology of liver diseases has changed profoundly in recent years; just think of the almost total disappearance of hepatitis C virus infection. Patients are more likely to present with liver diseases caused by the metabolic syndrome and excessive alcohol use. In addition, despite the application of the six-monthly surveillance for hepatocellular carcinoma (HCC) in patients with cirrhosis, a significant proportion of patients are diagnosed with HCC in the intermediate-advanced stages. More recently, selected cases of intrahepatic (ICCA) and perihilar (PCCA) cholangiocarcinoma and unresectable liver metastases from colorectal cancer (CRC) have become indications for LT. Bacterial infections, often caused by antibiotic-resistant strains, are currently the major risk factor, together with continued excessive alcohol intake, for the development of “acute or chronic liver failure” (ACLF) or “acute alcoholic hepatitis” (AAH), both associated with high short-term mortality without LT. In the current scenario where the indications for LT are rapidly changing, it is important to highlight that the type of potential recipients has also changed profoundly. A growing percentage of patients come to LT evaluation at an advanced age, with cardio-metabolic comorbidities and with psycho-social problems that make their transplant evaluation particularly complex.

In the present Special Issue, we aim to collect several review and original articles that highlight the significant advances in the indications and in the selection process for LT. Specific chapters will be dedicated to the new oncologic indications for LT, such as HCC with extended criteria, iCCA, PCCA, and liver metastases for CRC. The advances in pharmacological treatment of HCC based on immunotherapies and/or loco-regional therapies that permit obtaining the downgrading or downstaging of HCC within accepted criteria for LT will be part of this Special Issue. Particular attention will be reserved for the use of DCD donors and the potential support of stem cell transplantation. Finally, a careful evaluation and treatment of cardiometabolic complications in the long term after LT will be reviewed.

In summary, this Special Issue will help readers to obtain an up-to-date and authoritative view of the new horizons of LT and improve the clinical management of patients with advanced liver diseases in the forthcoming future.

Dr. Pierluigi Toniutto
Guest Editor

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• liver transplantation
• acute or chronic liver diseases
• hepatitis C virus infection
• hepatocellular carcinoma (HCC)
• cirrhosis
• intrahepatic (ICCA), perihilar (PCCA) cholangiocarcinoma
• unresectable liver metastases
• acute or chronic liver failure (ACLF)
• acute alcoholic hepatitis (AAH)