Safety and Success in Modern Liver Transplantation

Liver transplantation has evolved to become safe standard-of-care therapy for patients with end-stage liver disease and certain hepatic malignancies. Careful recipient selection and appropriate utilization of brain dead, deceased from cardiac death, or living donors allow for excellent recipient outcomes. Meticulous attention to surgical detail and proactive management of potential technical complications are important for success. Most post-transplant complications can be efficiently managed at experienced transplant centers. In quality measurement, regulatory monitoring, and allocation policy, there is decreased emphasis on one-year patient and graft survival as stand-alone metrics and increased attention to composite outcomes that include waitlist mortality, allocation system equity, healthcare cost, and patient satisfaction. Novel strategies for organ preservation, the expanding field of transplant oncology, and progress in pursuit of immunologic tolerance indicate rising value of liver transplantation as a curative modality.