New Developments and Challenges in Liver Transplantation
Open accessAbstract
Liver disease is increasing in incidence and is the third most common cause of premature death in the United Kingdom and fourth in the United States. Liver disease accounts for 2 million deaths globally each year. Three-quarters of patients with liver disease are diagnosed at a late stage, with liver transplantation as the only definitive treatment. Thomas E. Starzl performed the first human liver transplant 60 years ago. It has since become an established treatment for end-stage liver disease, both acute and chronic, including metabolic diseases and primary and, at present piloting, secondary liver cancer. Advances in surgical and anaesthetic techniques, refined indications and contra-indications to transplantation, improved donor selection, immunosuppression and prognostic scoring have allowed the outcomes of liver transplantation to improve year on year. However, there are many limitations to liver transplantation. This review describes the milestones that have occurred in the development of liver transplantation, the current limitations and the ongoing research aimed at overcoming these challenges.
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Liver transplantation is limited by global donor shortages, excessive costs, and long-term adverse effects of immunosuppressive drugs.
“Its application is, however, limited by persistent constraints, including global donor shortages leading to waitlist times and death, excessive costs (surgery, long-term immunosuppression, and follow-up), and long-term adverse effects of infections, metabolic complications, and malignancies associated with immunosuppressive drugs [10, 11].”
From From signaling pathways to clinical trials: mesenchymal stem cells as multimodal regenerative architects in liver cirrhosis therapy (2025) · cites this paper as [11]
Sections 3.2 and 3.4 describe worldwide donor shortages, waiting-list deaths, and high transplantation costs; sections 2.2 and 4.6 describe risks from immunosuppression and its lifelong use. The paper does not specify the cited cost breakdown or clearly attribute metabolic complications to immunosuppressive drugs. (LLM, conf=0.86)
Experimental — accuracy not yet measuredLiver transplantation remains the only curative option for end-stage liver disease.
“Liver transplantation remains the only curative option for end-stage liver disease, and refinements in surgical procedures, immunosuppressive therapy, and postoperative management have significantly enhanced patient survival and quality of life.”
From From signaling pathways to clinical trials: mesenchymal stem cells as multimodal regenerative architects in liver cirrhosis therapy (2025) · cites this paper as [11]
Advanced stages of cirrhosis often require liver transplantation, which is undermined by donor shortage and logistical setbacks.
“Although early interventions can retard or reverse early injury, advanced stages often call for liver transplantation—a therapy undermined by donor shortage and logistical setbacks.”
From From signaling pathways to clinical trials: mesenchymal stem cells as multimodal regenerative architects in liver cirrhosis therapy (2025) · cites this paper as [11]
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- Authors
- Khalil, A., Quaglia, A., Gélat, P., Saffari, N., Rashidi, H., & Davidson, B.
- Affiliations
- The Royal Free Hospital (GB)
- University College London (GB)
- Corresponding author
- Khalil, Amjad
- Davidson, Brian
- Venue
- Journal of Clinical Medicine
- Publisher
- MDPI AG
- Published
- 2023-08-27
- Volume
- 12
- Issue
- 17
- Pages
- 5586
- ISSN
- 2077-0383 (ISSN-L)
- PMC
- PMC10488676
- OpenAlex
- W4386224189
- Cited by
- 40
- References
- 85
- Citations by year
- 2026: 10 · 2025: 18 · 2024: 12
- FWCI
- 2.59
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Clinical Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion, cc-by)
- Funders
- Wellington Hospital, HCA London And Rosetrees Trust (2020\100261)
- Topics
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Keywords
- liver transplantation, end-stage liver disease, history of liver transplantation, donor selection, immunosuppression, prognostic scoring, transplant indications and contraindications, liver cancer, metabolic liver disease, transplant outcomes
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