Download PDF
Semin Liver Dis 2010; 30(4): 411-421
DOI: 10.1055/s-0030-1267541
© Thieme Medical Publishers

Current Status and Future of Liver Transplantation

Robert M. Merion1 , 2
  • 1Section of Transplantation, University of Michigan, Ann Arbor, Michigan
  • 2Arbor Research Collaborative for Health, Ann Arbor, Michigan
Further Information

Publication History

Publication Date:
19 October 2010 (online)

    Permissions and Reprints

ABSTRACT

Liver transplantation has rapidly advanced from an experimental therapy to a mainstream treatment option for a wide range of acute and chronic liver diseases. Indications for liver transplant have evolved to include previously contraindicated conditions such as hepatocellular carcinoma and alcohol-related liver disease. Cirrhosis from chronic hepatitis C infection remains the most common indication today. Multidisciplinary evaluation for liver transplantation is intended to confirm the patient's suitability and identify the appropriate timing of transplant, although the latter is problematic as a result of the ongoing donor organ shortage. Deceased liver donors have been increasing in number, but increasing donor age has been associated with less satisfactory posttransplant results. Living donor liver transplant is a dramatic but very infrequent procedure; risk to the living donor is of paramount concern. The main focus of deceased donor allocation has transitioned from waiting time to estimation of the likelihood of death without transplant (medical urgency), and now relies upon a laboratory-based Model for End-Stage Liver Disease (MELD) score for candidates with chronic liver disease. Those with acute liver failure are prioritized ahead of those with chronic conditions. Although not used as a direct criterion for allocation, development of the concept of transplant survival benefit, i.e., the extra years of life attributable to transplant, has facilitated better ordering of those candidates likely to have the most benefit, while restricting access to those whose lives will be extended minimally or not at all. Overall posttransplant outcomes have steadily improved, with unadjusted 5-year patient survival rates of 77% among patients transplanted with MELD score between 15 and 20, and 72% for those with MELD scores between 21 and 30.

KEYWORDS

Liver transplantation - indications - waiting list - deceased organ donation - surgical technique - living donor liver transplant

REFERENCES

  • 1 Starzl T E, Groth C G, Brettschneider L et al.. Orthotopic homotransplantation of the human liver.  Ann Surg. 1968;  168(3) 392-415
    CrossrefPubMedGoogle Scholar
  • 2 Starzl T E, Marchioro T L, Vonkaulla K N, Hermann G, Brittain R S, Waddell W R. Homotransplantation of the liver in humans.  Surg Gynecol Obstet. 1963;  117 659-676
    PubMedGoogle Scholar
  • 3 Starzl T E, Fung J J. Themes of liver transplantation.  Hepatology. 2010;  51(6) 1869-1884
    CrossrefPubMedGoogle Scholar
  • 4 Calne R Y, Rolles K, White D J et al.. Cyclosporin A initially as the only immunosuppressant in 34 recipients of cadaveric organs: 32 kidneys, 2 pancreases, and 2 livers.  Lancet. 1979;  2(8151) 1033-1036
    PubMedGoogle Scholar
  • 5 Millard C E. The NIH Consensus Development Conference on liver transplantation.  R I Med J. 1984;  67(2) 69-71
    PubMedGoogle Scholar
  • 6 2008 Annual Report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry for Transplant Recipients: Transplant Data 1998–2007. Rockville, MD; U.S. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation 2009
    Google Scholar
  • 7 Thuluvath P J, Guidinger M K, Fung J J, Johnson L B, Rayhill S C, Pelletier S J. Liver transplantation in the United States, 1999-2008.  Am J Transplant. 2010;  10(4 Pt 2) 1003-1019
    CrossrefPubMedGoogle Scholar
  • 8 Perrillo R. Hepatitis B virus prevention strategies for antibody to hepatitis B core antigen-positive liver donation: a survey of North American, European, and Asian-Pacific transplant programs.  Liver Transpl. 2009;  15(2) 223-232
    CrossrefPubMedGoogle Scholar
  • 9 Fan S T, Cheung S T, Lo C M. Indications for liver transplantation in patients with chronic hepatitis B and C virus infection and hepatocellular carcinoma.  J Gastroenterol Hepatol. 2000;  15(Suppl) E181-E186
    CrossrefPubMedGoogle Scholar
  • 10 Xiao L, Fu Z R, Ding G S et al.. Liver transplantation for hepatitis B virus-related hepatocellular carcinoma: one center's experience in China.  Transplant Proc. 2009;  41(5) 1717-1721
    CrossrefPubMedGoogle Scholar
  • 11 Lo C M, Fan S T, Liu C L, Lai C L, Wong J. Prophylaxis and treatment of recurrent hepatitis B after liver transplantation.  Transplantation. 2003;  75(3, Suppl) S41-S44
    CrossrefPubMedGoogle Scholar
  • 12 Gerhardt T C, Goldstein R M, Urschel H C et al.. Alcohol use following liver transplantation for alcoholic cirrhosis.  Transplantation. 1996;  62(8) 1060-1063
    CrossrefPubMedGoogle Scholar
  • 13 Krom R A. Liver transplantation and alcohol: who should get transplants?.  Hepatology. 1994;  20(1 Pt 2) 28S-32S
    PubMedGoogle Scholar
  • 14 Beresford T P, Turcotte J G, Merion R et al.. A rational approach to liver transplantation for the alcoholic patient.  Psychosomatics. 1990;  31(3) 241-254
    CrossrefPubMedGoogle Scholar
  • 15 Lucey M R, Merion R M, Henley K S et al.. Selection for and outcome of liver transplantation in alcoholic liver disease.  Gastroenterology. 1992;  102(5) 1736-1741
    PubMedGoogle Scholar
  • 16 Snyder S L, Drooker M, Strain J J. A survey estimate of academic liver transplant teams' selection practices for alcohol-dependent applicants.  Psychosomatics. 1996;  37(5) 432-437
    CrossrefPubMedGoogle Scholar
  • 17 Weinrieb R M, Van Horn D H, McLellan A T, Lucey M R. Interpreting the significance of drinking by alcohol-dependent liver transplant patients: fostering candor is the key to recovery.  Liver Transpl. 2000;  6(6) 769-776
    CrossrefPubMedGoogle Scholar
  • 18 DiMartini A, Day N, Dew M A et al.. Alcohol consumption patterns and predictors of use following liver transplantation for alcoholic liver disease.  Liver Transpl. 2006;  12(5) 813-820
    CrossrefPubMedGoogle Scholar
  • 19 DiMartini A, Day N, Dew M A et al.. Alcohol use following liver transplantation: a comparison of follow-up methods.  Psychosomatics. 2001;  42(1) 55-62
    CrossrefPubMedGoogle Scholar
  • 20 Tringali R A, Trzepacz P T, DiMartini A, Dew M A. Assessment and follow-up of alcohol-dependent liver transplantation patients. A clinical cohort.  Gen Hosp Psychiatry. 1996;  18(6, Suppl) 70S-77S
    CrossrefPubMedGoogle Scholar
  • 21 Campbell Jr D A, Magee J C, Punch J D, Merion R M, Turcotte J G, Bromberg J S. One center's experience with liver transplantation: alcohol use relapse over the long-term.  Liver Transpl Surg. 1998;  4(5, Suppl 1) S58-S64
    CrossrefPubMedGoogle Scholar
  • 22 Mazzaferro V, Regalia E, Doci R et al.. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis.  N Engl J Med. 1996;  334(11) 693-699
    CrossrefPubMedGoogle Scholar
  • 23 D'Amico F, Schwartz M, Vitale A et al.. Predicting recurrence after liver transplantation in patients with hepatocellular carcinoma exceeding the up-to-seven criteria.  Liver Transpl. 2009;  15(10) 1278-1287
    CrossrefPubMedGoogle Scholar
  • 24 Mazzaferro V, Llovet J M, Miceli R Metroticket Investigator Study Group et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis.  Lancet Oncol. 2009;  10(1) 35-43
    CrossrefPubMedGoogle Scholar
  • 25 Yao F Y. Liver transplantation for hepatocellular carcinoma: beyond the Milan criteria.  Am J Transplant. 2008;  8(10) 1982-1989
    CrossrefPubMedGoogle Scholar
  • 26 Fan S T. Selection of HCC patients for liver transplantation: the Milan criteria, Hangzhou criteria and beyond.  Hepatobiliary Pancreat Dis Int. 2008;  7(3) 233-234
    PubMedGoogle Scholar
  • 27 Volk M, Marrero J A. Liver transplantation for hepatocellular carcinoma: who benefits and who is harmed?.  Gastroenterology. 2008;  134(5) 1612-1614
    CrossrefPubMedGoogle Scholar
  • 28 Volk M L, Vijan S, Marrero J A. A novel model measuring the harm of transplanting hepatocellular carcinoma exceeding Milan criteria.  Am J Transplant. 2008;  8(4) 839-846
    CrossrefPubMedGoogle Scholar
  • 29 Yao F Y, Ferrell L, Bass N M et al.. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival.  Hepatology. 2001;  33(6) 1394-1403
    CrossrefPubMedGoogle Scholar
  • 30 Lo C. Downstaging of hepatocellular carcinoma before transplantation: an advance in therapy or just another selection criterion.  Am J Transplant. 2008;  8(12) 2485-2486
    CrossrefPubMedGoogle Scholar
  • 31 Heimbach J K. Liver transplantation for hepatocellular carcinoma.  Cancer J. 2008;  14(2) 95-99
    CrossrefPubMedGoogle Scholar
  • 32 Freeman Jr R B. Transplantation for hepatocellular carcinoma: the Milan criteria and beyond.  Liver Transpl. 2006;  12(11, Suppl 2) S8-S13
    CrossrefPubMedGoogle Scholar
  • 33 Otto G, Herber S, Heise M et al.. Response to transarterial chemoembolization as a biological selection criterion for liver transplantation in hepatocellular carcinoma.  Liver Transpl. 2006;  12(8) 1260-1267
    CrossrefPubMedGoogle Scholar
  • 34 Yao F Y, Hirose R, LaBerge J M et al.. A prospective study on downstaging of hepatocellular carcinoma prior to liver transplantation.  Liver Transpl. 2005;  11(12) 1505-1514
    CrossrefPubMedGoogle Scholar
  • 35 Yao F Y, Kerlan Jr R K, Hirose R et al.. Excellent outcome following down-staging of hepatocellular carcinoma prior to liver transplantation: an intention-to-treat analysis.  Hepatology. 2008;  48(3) 819-827
    CrossrefPubMedGoogle Scholar
  • 36 Pomfret E A, Washburn K, Wald C et al.. Report of a national conference on liver allocation in patients with hepatocellular carcinoma in the United States.  Liver Transpl. 2010;  16(3) 262-278
    CrossrefPubMedGoogle Scholar
  • 37 de Alwis N M, Day C P. Non-alcoholic fatty liver disease: the mist gradually clears.  J Hepatol. 2008;  48(Suppl 1) S104-S112
    PubMedGoogle Scholar
  • 38 Burke A, Lucey M R. Non-alcoholic fatty liver disease, non-alcoholic steatohepatitis and orthotopic liver transplantation.  Am J Transplant. 2004;  4(5) 686-693
    CrossrefPubMedGoogle Scholar
  • 39 Grambsch P M, Dickson E R, Wiesner R H, Langworthy A. Application of the Mayo primary biliary cirrhosis survival model to Mayo liver transplant patients.  Mayo Clin Proc. 1989;  64(6) 699-704
    PubMedGoogle Scholar
  • 40 Abu-Elmagd K M, Malinchoc M, Dickson E R et al.. Efficacy of hepatic transplantation in patients with primary sclerosing cholangitis.  Surg Gynecol Obstet. 1993;  177(4) 335-344
    PubMedGoogle Scholar
  • 41 Brandsaeter B, Isoniemi H, Broomé U et al.. Liver transplantation for primary sclerosing cholangitis; predictors and consequences of hepatobiliary malignancy.  J Hepatol. 2004;  40(5) 815-822
    CrossrefPubMedGoogle Scholar
  • 42 Kim W R, Poterucha J J, Wiesner R H et al.. The relative role of the Child-Pugh classification and the Mayo natural history model in the assessment of survival in patients with primary sclerosing cholangitis.  Hepatology. 1999;  29(6) 1643-1648
    CrossrefPubMedGoogle Scholar
  • 43 Ricci P, Therneau T M, Malinchoc M et al.. A prognostic model for the outcome of liver transplantation in patients with cholestatic liver disease.  Hepatology. 1997;  25(3) 672-677
    CrossrefPubMedGoogle Scholar
  • 44 Talwalkar J A, Seaberg E, Kim W R, Wiesner R H. National Institutes of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database Group . Predicting clinical and economic outcomes after liver transplantation using the Mayo primary sclerosing cholangitis model and Child-Pugh score.  Liver Transpl. 2000;  6(6) 753-758
    CrossrefPubMedGoogle Scholar
  • 45 Baerg J, Zuppan C, Klooster M. Biliary atresia—a fifteen-year review of clinical and pathologic factors associated with liver transplantation.  J Pediatr Surg. 2004;  39(6) 800-803
    CrossrefPubMedGoogle Scholar
  • 46 Prabhakran K. Biliary atresia: Kasai and liver transplantation.  Ann Acad Med Singapore. 1991;  20(4) 540-542
    PubMedGoogle Scholar
  • 47 Burdelski M, Rogiers X. Liver transplantation in metabolic disorders.  Acta Gastroenterol Belg. 1999;  62(3) 300-305
    PubMedGoogle Scholar
  • 48 Kayler L K, Merion R M, Lee S et al.. Long-term survival after liver transplantation in children with metabolic disorders.  Pediatr Transplant. 2002;  6(4) 295-300
    CrossrefPubMedGoogle Scholar
  • 49 Kayler L K, Rasmussen C S, Dykstra D M et al.. Liver transplantation in children with metabolic disorders in the United States.  Am J Transplant. 2003;  3(3) 334-339
    CrossrefPubMedGoogle Scholar
  • 50 Pratschke J, Steinmüller T, Bechstein W O et al.. Orthotopic liver transplantation for hepatic associated metabolic disorders.  Clin Transplant. 1998;  12(3) 228-232
    PubMedGoogle Scholar
  • 51 Gruessner R W. Preemptive liver transplantation from a living related donor for primary hyperoxaluria type I.  N Engl J Med. 1998;  338(26) 1924
    PubMedGoogle Scholar
  • 52 Jamieson N V. European PHI Transplantation Study Group . A 20-year experience of combined liver/kidney transplantation for primary hyperoxaluria (PH1): the European PH1 transplant registry experience 1984-2004.  Am J Nephrol. 2005;  25(3) 282-289
    CrossrefPubMedGoogle Scholar
  • 53 Jamieson N V. The results of combined liver/kidney transplantation for primary hyperoxaluria (PH1) 1984-1997. The European PH1 transplant registry report. European PH1 Transplantation Study Group.  J Nephrol. 1998;  11(Suppl 1) 36-41
    PubMedGoogle Scholar
  • 54 Jamieson N V. The European Primary Hyperoxaluria Type 1 Transplant Registry report on the results of combined liver/kidney transplantation for primary hyperoxaluria 1984-1994. European PH1 Transplantation Study Group.  Nephrol Dial Transplant. 1995;  10(Suppl 8) 33-37
    PubMedGoogle Scholar
  • 55 Liou I W, Larson A M. Role of liver transplantation in acute liver failure.  Semin Liver Dis. 2008;  28(2) 201-209
    Article in Thieme ConnectPubMedGoogle Scholar
  • 56 Renner E L. How to decide when to list a patient with acute liver failure for liver transplantation? Clichy or King's College criteria, or something else?.  J Hepatol. 2007;  46(4) 554-557
    CrossrefPubMedGoogle Scholar
  • 57 Bernal W, Wendon J. Liver transplantation in adults with acute liver failure.  J Hepatol. 2004;  40(2) 192-197
    CrossrefPubMedGoogle Scholar
  • 58 McCashland T M, Shaw Jr B W, Tape E. The American experience with transplantation for acute liver failure.  Semin Liver Dis. 1996;  16(4) 427-433
    Article in Thieme ConnectPubMedGoogle Scholar
  • 59 Bismuth H, Samuel D, Castaing D, Williams R, Pereira S P. Liver transplantation in Europe for patients with acute liver failure.  Semin Liver Dis. 1996;  16(4) 415-425
    Article in Thieme ConnectPubMedGoogle Scholar
  • 60 Mirza D F, Mohamed R, Mutimer D J, McMaster P. Timing and candidacy for transplantation in acute liver failure: the European experience.  Liver Transpl Surg. 1995;  1(3) 182-186
    CrossrefPubMedGoogle Scholar
  • 61 Chapman R W, Forman D, Peto R, Smallwood R. Liver transplantation for acute hepatic failure?.  Lancet. 1990;  335(8680) 32-35
    CrossrefPubMedGoogle Scholar
  • 62 Lee W M, Hynan L S, Rossaro L Acute Liver Failure Study Group et al. Intravenous N-acetylcysteine improves transplant-free survival in early stage non-acetaminophen acute liver failure.  Gastroenterology. 2009;  137(3) 856-864, 864, e1
    CrossrefPubMedGoogle Scholar
  • 63 Foley D P, Collins B R, Magee J C et al.. Bile acids in xenogeneic ex-vivo liver perfusion: function of xenoperfused livers and compatibility with human bile salts and porcine livers.  Transplantation. 2000;  69(2) 242-248
    CrossrefPubMedGoogle Scholar
  • 64 Sussman N L, Kelly J H. Extracorporeal liver support: cell-based therapy for the failing liver.  Am J Kidney Dis. 1997;  30(5, Suppl 4) S66-S71
    CrossrefPubMedGoogle Scholar
  • 65 National Vital Statistics System .Available at: http://www.cdc.gov/nchs/nvss.htm Accessed July 21, 2010
  • 66 Mathur A K, Sonnenday C J, Merion R M. Race and ethnicity in access to and outcomes of liver transplantation: a critical literature review.  Am J Transplant. 2009;  9(12) 2662-2668
    CrossrefPubMedGoogle Scholar
  • 67 Mathur A K, Schaubel D E, Gong Q, Guidinger M K, Merion R M. Racial and ethnic disparities in access to liver transplantation.  Liver Transpl. 2010;  16 1033-1040
    CrossrefPubMedGoogle Scholar
  • 68 Brockmann J G, Vaidya A, Reddy S, Friend P J. Retrieval of abdominal organs for transplantation.  Br J Surg. 2006;  93(2) 133-146
    CrossrefPubMedGoogle Scholar
  • 69 Abu-Elmagd K, Fung J, Bueno J et al.. Logistics and technique for procurement of intestinal, pancreatic, and hepatic grafts from the same donor.  Ann Surg. 2000;  232(5) 680-687
    CrossrefPubMedGoogle Scholar
  • 70 Ackermann J R, Snell M E. Cadaveric renal transplantation: a technique for donor kidney removal.  Br J Urol. 1968;  40(5) 515-521
    CrossrefPubMedGoogle Scholar
  • 71 Starzl T E, Miller C, Broznick B, Makowka L. An improved technique for multiple organ harvesting.  Surg Gynecol Obstet. 1987;  165(4) 343-348
    PubMedGoogle Scholar
  • 72 Rosenthal J T, Shaw Jr B W, Hardesty R L, Griffith B P, Starzl T E, Hakala T R. Principles of multiple organ procurement from cadaver donors.  Ann Surg. 1983;  198(5) 617-621
    CrossrefPubMedGoogle Scholar
  • 73 Renz J F, Yersiz H, Reichert P R et al.. Split-liver transplantation: a review.  Am J Transplant. 2003;  3(11) 1323-1335
    CrossrefPubMedGoogle Scholar
  • 74 Zamir G, Olthoff K M, Desai N, Markmann J F, Shaked A. Toward further expansion of the organ pool for adult liver recipients: splitting the cadaveric liver into right and left lobes.  Transplantation. 2002;  74(12) 1757-1761
    PubMedGoogle Scholar
  • 75 Azoulay D, Castaing D, Adam R et al.. Split-liver transplantation for two adult recipients: feasibility and long-term outcomes.  Ann Surg. 2001;  233(4) 565-574
    CrossrefPubMedGoogle Scholar
  • 76 Reyes J, Gerber D, Mazariegos G V et al.. Split-liver transplantation: a comparison of ex vivo and in situ techniques.  J Pediatr Surg. 2000;  35(2) 283-289 discussion 289-290
    CrossrefPubMedGoogle Scholar
  • 77 Busuttil R W, Goss J A. Split liver transplantation.  Ann Surg. 1999;  229(3) 313-321
    CrossrefPubMedGoogle Scholar
  • 78 Rogiers X, Malagó M, Gawad K et al.. In situ splitting of cadaveric livers. The ultimate expansion of a limited donor pool.  Ann Surg. 1996;  224(3) 331-339 discussion 339-341
    CrossrefPubMedGoogle Scholar
  • 79 Emond J C, Whitington P F, Broelsch C E. Overview of reduced-size liver transplantation.  Clin Transplant. 1991;  5(2 part 2) 168-173
    PubMedGoogle Scholar
  • 80 Humar A, Ramcharan T, Sielaff T D et al.. Split liver transplantation for two adult recipients: an initial experience.  Am J Transplant. 2001;  1(4) 366-372
    CrossrefPubMedGoogle Scholar
  • 81 Englesbe M J, Merion R M. The riskiest job in medicine: transplant surgeons and organ procurement travel.  Am J Transplant. 2009;  9(10) 2406-2415
    CrossrefPubMedGoogle Scholar
  • 82 Englesbe M J, Shah S, Cutler J A Michigan Donor Travel Forum et al. Improving organ procurement travel practices in the United States: proceedings from the Michigan Donor Travel Forum.  Am J Transplant. 2010;  10(3) 458-463
    CrossrefPubMedGoogle Scholar
  • 83 Loinaz C, González E M. Marginal donors in liver transplantation.  Hepatogastroenterology. 2000;  47(31) 256-263
    PubMedGoogle Scholar
  • 84 Totsuka E, Fung J J, Ishii T et al.. Influence of donor condition on postoperative graft survival and function in human liver transplantation.  Transplant Proc. 2000;  32(2) 322-326
    CrossrefPubMedGoogle Scholar
  • 85 Yersiz H, Shaked A, Olthoff K et al.. Correlation between donor age and the pattern of liver graft recovery after transplantation.  Transplantation. 1995;  60(8) 790-794
    PubMedGoogle Scholar
  • 86 Feng S, Goodrich N P, Bragg-Gresham J L et al.. Characteristics associated with liver graft failure: the concept of a donor risk index.  Am J Transplant. 2006;  6(4) 783-790
    CrossrefPubMedGoogle Scholar
  • 87 Merion R M, Pelletier S J, Goodrich N, Englesbe M J, Delmonico F L. Donation after cardiac death as a strategy to increase deceased donor liver availability.  Ann Surg. 2006;  244(4) 555-562
    PubMedGoogle Scholar
  • 88 D'alessandro A M, Hoffmann R M, Knechtle S J et al.. Liver transplantation from controlled non-heart-beating donors.  Surgery. 2000;  128(4) 579-588
    CrossrefPubMedGoogle Scholar
  • 89 Skaro A I, Jay C L, Baker T B et al.. The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: the untold story.  Surgery. 2009;  146(4) 543-552 discussion 552-553
    CrossrefPubMedGoogle Scholar
  • 90 Gibbons R D, Duan N, Meltzer D. Inequities in liver transplant allocation.  Science. 2000;  289(5479) 549-550
    CrossrefPubMedGoogle Scholar
  • 91 Keeffe E B. Summary of guidelines on organ allocation and patient listing for liver transplantation.  Liver Transpl Surg. 1998;  4(5, Suppl 1) S108-S114
    PubMedGoogle Scholar
  • 92 Neuberger J, Adams D, MacMaster P, Maidment A, Speed M. Assessing priorities for allocation of donor liver grafts: survey of public and clinicians.  BMJ. 1998;  317(7152) 172-175
    PubMedGoogle Scholar
  • 93 Delmonico F L, Jenkins R L, Freeman R et al.. The high-risk liver allograft recipient. Should allocation policy consider outcome?.  Arch Surg. 1992;  127(5) 579-584
    PubMedGoogle Scholar
  • 94 Starzl T E, Gordon R D, Tzakis A et al.. Equitable allocation of extrarenal organs: with special reference to the liver.  Transplant Proc. 1988;  20(1) 131-138
    PubMedGoogle Scholar
  • 95 Committee on Organ Procurement and Transplantation Policy .Organ procurement and transplantation: assessing current policies and the potential impact of the DHHS final rule. Washington, DC; National Academies Press 1999
    Google Scholar
  • 96 Malinchoc M, Kamath P S, Gordon F D, Peine C J, Rank J, ter Borg P C. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts.  Hepatology. 2000;  31(4) 864-871
    CrossrefPubMedGoogle Scholar
  • 97 Wiesner R, Edwards E, Freeman R United Network for Organ Sharing Liver Disease Severity Score Committee et al. Model for end-stage liver disease (MELD) and allocation of donor livers.  Gastroenterology. 2003;  124(1) 91-96
    CrossrefPubMedGoogle Scholar
  • 98 Wiesner R H, McDiarmid S V, Kamath P S et al.. MELD and PELD: application of survival models to liver allocation.  Liver Transpl. 2001;  7(7) 567-580
    CrossrefPubMedGoogle Scholar
  • 99 Edwards E B, Harper A M. The impact of MELD on OPTN liver allocation: preliminary results.  Clin Transpl. 2002;  21-28
    PubMedGoogle Scholar
  • 100 McDiarmid S V, Anand R, Lindblad A S. Principal Investigators and Institutions of the Studies of Pediatric Liver Transplantation (SPLIT) Research Group . Development of a pediatric end-stage liver disease score to predict poor outcome in children awaiting liver transplantation.  Transplantation. 2002;  74(2) 173-181
    CrossrefPubMedGoogle Scholar
  • 101 Davies D B. The impact of PELD on OPTN liver allocation: preliminary results.  Clin Transpl. 2003;  13-20
    PubMedGoogle Scholar
  • 102 McDiarmid S V, Goodrich N P, Harper A M, Merion R M. Liver transplantation for status 1: the consequences of good intentions.  Liver Transpl. 2007;  13(5) 699-707
    CrossrefPubMedGoogle Scholar
  • 103 Organ Procurement and Transplantation Network .Policy 3.6. Allocation of deceased livers. Available at: http://www.optn.org/PoliciesandBylaws/policies/pdfs/policy_8.pdf Accessed August 3, 2006
    Google Scholar
  • 104 Sharma P, Balan V, Hernandez J L et al.. Liver transplantation for hepatocellular carcinoma: the MELD impact.  Liver Transpl. 2004;  10(1) 36-41
    CrossrefPubMedGoogle Scholar
  • 105 Washburn K, Edwards E, Harper A, Freeman R. Hepatocellular carcinoma patients are advantaged in the current liver transplant allocation system.  Am J Transplant. 2010;  10(7) 1643-1648
    CrossrefPubMedGoogle Scholar
  • 106 Freeman Jr R B, Gish R G, Harper A et al.. Model for end-stage liver disease (MELD) exception guidelines: results and recommendations from the MELD Exception Study Group and Conference (MESSAGE) for the approval of patients who need liver transplantation with diseases not considered by the standard MELD formula.  Liver Transpl. 2006;  12(12, Suppl 3) S128-S136
    CrossrefPubMedGoogle Scholar
  • 107 Schaubel D E, Guidinger M K, Biggins S W et al.. Survival benefit-based deceased-donor liver allocation.  Am J Transplant. 2009;  9(4 Pt 2) 970-981
    CrossrefPubMedGoogle Scholar
  • 108 Biggins S W, Kim W R, Terrault N A et al.. Evidence-based incorporation of serum sodium concentration into MELD.  Gastroenterology. 2006;  130(6) 1652-1660
    CrossrefPubMedGoogle Scholar
  • 109 Kim W R, Biggins S W, Kremers W K et al.. Hyponatremia and mortality among patients on the liver-transplant waiting list.  N Engl J Med. 2008;  359(10) 1018-1026
    CrossrefPubMedGoogle Scholar
  • 110 Merion R M, Schaubel D E, Dykstra D M, Freeman R B, Port F K, Wolfe R A. The survival benefit of liver transplantation.  Am J Transplant. 2005;  5(2) 307-313
    CrossrefPubMedGoogle Scholar
  • 111 Pomfret E A, Fryer J P, Sima C S, Lake J R, Merion R M. Liver and intestine transplantation in the United States, 1996-2005.  Am J Transplant. 2007;  7(5 Pt 2) 1376-1389
    CrossrefPubMedGoogle Scholar
  • 112 Schaubel D E, Sima C S, Goodrich N P, Feng S, Merion R M. The survival benefit of deceased donor liver transplantation as a function of candidate disease severity and donor quality.  Am J Transplant. 2008;  8(2) 419-425
    CrossrefPubMedGoogle Scholar
  • 113 Samuel D, Feray C. Recurrence of hepatitis C virus infection after liver transplantation.  J Hepatol. 1999;  31(Suppl 1) 217-221
    CrossrefPubMedGoogle Scholar
  • 114 Terrault N A. Hepatitis C therapy before and after liver transplantation.  Liver Transpl. 2008;  14(Suppl 2) S58-S66
    CrossrefPubMedGoogle Scholar
  • 115 Xirouchakis E, Triantos C, Manousou P et al.. Pegylated-interferon and ribavirin in liver transplant candidates and recipients with HCV cirrhosis: systematic review and meta-analysis of prospective controlled studies.  J Viral Hepat. 2008;  15(10) 699-709
    CrossrefPubMedGoogle Scholar
  • 116 Everson G T, Kulig C C. Antiviral therapy for hepatitis C in the setting of liver transplantation.  Curr Treat Options Gastroenterol. 2006;  9(6) 520-529
    CrossrefPubMedGoogle Scholar
  • 117 Houben K W, McCall J L. Liver transplantation for hepatocellular carcinoma in patients without underlying liver disease: a systematic review.  Liver Transpl Surg. 1999;  5(2) 91-95
    CrossrefPubMedGoogle Scholar
  • 118 Whitington P F. Living donor liver transplantation: ethical considerations.  J Hepatol. 1996;  24(5) 625-627
    PubMedGoogle Scholar
  • 119 Piper J B, Whitington P F, Woodle E S, Newell K A, Alonso E M, Thistlethwaite J R. Living related liver transplantation in children: a report of the first 58 recipients at the University of Chicago.  Transpl Int. 1994;  7(Suppl 1) S111-S113
    CrossrefPubMedGoogle Scholar
  • 120 Roberts J P, Hulbert-Shearon T E, Merion R M, Wolfe R A, Port F K. Influence of graft type on outcomes after pediatric liver transplantation.  Am J Transplant. 2004;  4(3) 373-377
    CrossrefPubMedGoogle Scholar
  • 121 Lo C M, Fan S T, Liu C L et al.. Adult-to-adult living donor liver transplantation using extended right lobe grafts.  Ann Surg. 1997;  226(3) 261-269 discussion 269-270
    CrossrefPubMedGoogle Scholar
  • 122 Marcos A, Fisher R A, Ham J M et al.. Right lobe living donor liver transplantation.  Transplantation. 1999;  68(6) 798-803
    CrossrefPubMedGoogle Scholar
  • 123 Trotter J F, Wachs M, Everson G T, Kam I. Adult-to-adult transplantation of the right hepatic lobe from a living donor.  N Engl J Med. 2002;  346(14) 1074-1082
    CrossrefPubMedGoogle Scholar
  • 124 Olthoff K M, Merion R M, Ghobrial R M A2ALL Study Group et al. Outcomes of 385 adult-to-adult living donor liver transplant recipients: a report from the A2ALL Consortium.  Ann Surg. 2005;  242(3) 314-323 discussion 323-325
    PubMedGoogle Scholar
  • 125 Ghobrial R M, Freise C E, Trotter J F A2ALL Study Group et al. Donor morbidity after living donation for liver transplantation.  Gastroenterology. 2008;  135(2) 468-476
    CrossrefPubMedGoogle Scholar
  • 126 Berg C L, Gillespie B W, Merion R M A2ALL Study Group et al. Improvement in survival associated with adult-to-adult living donor liver transplantation.  Gastroenterology. 2007;  133(6) 1806-1813
    CrossrefPubMedGoogle Scholar
  • 127 Trotter J F, Adam R, Lo C M, Kenison J. Documented deaths of hepatic lobe donors for living donor liver transplantation.  Liver Transpl. 2006;  12(10) 1485-1488
    CrossrefPubMedGoogle Scholar

Robert M MerionM.D. F.A.C.S. 

Professor of Surgery, Section of Transplantation, University of Michigan

2922 Taubman Center, SPC5331, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5331

Email: merionb@umich.edu

      >