Recent advances in liver transplantation for the practicing gastroenterologist

Ranjan Mascarenhas, Ahmet Gurakar

Research output: Contribution to journalReview article

Abstract

Liver transplantation is the definitive therapy for end-stage liver disease of various etiologies as well as acute liver failure and early-stage hepatocellular carcinoma. The Model for End-Stage Liver Disease (MELD) score is essential for organ allocation in the United States. Addition of the serum sodium level to the MELD score is a recent development that helps prognosticate cirrhotic patients with hyponatremia, a commonly seen manifestation of end-stage liver disease. The currently used Milan criteria for hepatocellular carcinoma have been expanded with some success at certain transplant centers, and tumor downstaging prior to transplant is being used more frequently. The tremendous shortage of donor organs continues to be the major limitation of this life-saving therapy. This has led to the use of extended-criteria donors, donation after cardiac death, split liver grafts, and live donor liver transplants. Renal dysfunction following liver transplant requires close monitoring and dose adjustments of immunosuppressive medications. Although most liver transplants in the United States are for chronic hepatitis C infection and its sequelae, hepatitis C virus recurrence is a common problem that is challenging to treat in the post-transplant population.

Original languageEnglish (US)
Pages (from-to)443-450
Number of pages8
JournalGastroenterology and Hepatology
Volume5
Issue number6
StatePublished - Jun 1 2009

Keywords

  • Donation after cardiac death
  • Hepatocellular carcinoma
  • Live donor liver transplant
  • Model for end-stage liver disease
  • Orthotopic liver transplant

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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