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Limitations of current liver donor allocation systems and the impact of newer indications for liver transplantation

Burra, P; Samuel, D; Sundaram, V; Duvoux, C; Petrowsky, H; Terrault, N; Jalan, R; (2021) Limitations of current liver donor allocation systems and the impact of newer indications for liver transplantation. Journal of Hepatology , 75 S178-S190. 10.1016/j.jhep.2021.01.007.

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Abstract

Liver transplantation represents a life-saving treatment for patients with decompensated cirrhosis, a severe condition associated with a high risk of waiting list mortality. When decompensation occurs rapidly in the presence of extrahepatic organ failures, the condition is called acute-on-chronic liver failure, which is associated with an even higher risk of death, though liver transplantation can also markedly improve survival in affected patients. However, there are still gaps in our understanding of how to optimise prioritisation and organ allocation, as well as survival among patients with acute-on-chronic liver failure (both before and after transplant). Moreover, it is urgent to address inequalities in access to liver transplantation in patients with severe alcoholic hepatitis and non-alcoholic steatohepatitis. Several controversies still exist regarding gender and regional disparities, as well as the use of suboptimal donor grafts. In this review, we aim to provide a critical perspective on the role of liver transplantation in patients with decompensated cirrhosis and address areas of ongoing uncertainty.

Type: Article
Title: Limitations of current liver donor allocation systems and the impact of newer indications for liver transplantation
DOI: 10.1016/j.jhep.2021.01.007
Publisher version: https://doi.org/10.1016/j.jhep.2021.01.007
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.
Keywords: Liver transplantation; Acute-on-chronic liver failure; Non-alcoholic steatohepatitis; Alcohol-associated acute hepatitis; Allocation models; Futility; Waiting list
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
URI: https://discovery.ucl.ac.uk/id/eprint/10131436
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