Future Map of Liver Transplantation

Abstract

Liver transplantation (LT) is known to be the final solution for patients suffering from hepatic decompensation and its sequalae. There will be changing trend in liver transplant indications in the future. Non-Alcoholic Steatohepatitis (NASH) related cirrhosis will be the leading indication for LT in Europe, United State and in the Middle East. There will be change in the patient characteristics who are in need for liver transplantation. Liver transplant teams will encounter cases with NAFLD (Non-Alcoholic Fatty Liver Disease) and their linked comorbidity. There will be unmet need for expanding donor pool in the future. Direct-acting antivirals (DAAs) led to dramatic change in HCV treatment and have opened the road for using HCV positive organs as a trial to increase the donor pool. However, to generalize this concept in living donor liver transplant in Countries which had high volume of HCV cases who treated by DAAs as Egypt, this need consensus agreement between different liver transplant centers in the Country. There will be changing trend in NAFLD patient management pre and post liver transplant. There will be expanding role for bariatric surgery specially sleeve gastrectomy before or during LT surgery. Immunosuppression need to be modified and optimized to the patient metabolic risk profile. NAFLD associated comorbidities need specific management preand post-transplant. Multidisciplinary Teamwork will be the key for successful outcome of liver transplant operations.