Innovations in liver transplantation in 2020, position of the Belgian Liver Intestine Advisory Committee (BeLIAC)

Abstract

Liver transplantation (LT) remains the only curative option for patients suffering from end-stage liver disease, acute liver failure and selected hepatocellular carcinomas and access to the LT-waiting list is limited to certain strict indications. However, LT has shown survival advantages for patients in certain indications such as acute alcoholic hepatitis, hepatocellular carcinoma outside Milan criteria and colorectal cancer metastases. These newer indications increase the pressure in an already difficult context of organ shortage. Strategies to increase the transplantable organ pool are therefore needed. We will discuss here the use of HCV positive grafts as the use of normothermic isolated liver perfusion. Belgian Liver Intestine Advisory Committee (BeLIAC) from the Belgian Transplant Society (BTS) aims to guarantee the balance between the new indications and the available resources.

The impact of COVID-19 on liver transplantation: challenges and perspectives

“…The risk and benefit ratio of mortality associated with being on the waiting list without transplantation versus potential to acquire COVID-19 infection peri-operatively in the hospital was to be discussed with patients to individualize the decision. 47 …”

“…33,46 Earlier in the pandemic, the Belgian Liver Intestine Transplant Committee (BeLIAC) prohibited the use of COVID-19-positive donors due to the risks to patients and healthcare staff. 47 They also recommended testing of all donors. BeLIAC also recommended LT should be given priority access to non-COVID resources, considering that this is a life-saving surgery.…”

“…The risk and benefit ratio of mortality associated with being on the waiting list without transplantation versus potential to acquire COVID-19 infection peri-operatively in the hospital was to be discussed with patients to individualize the decision. 47 Due to limited resources, it was also recommended to consider the expected outcomes while selecting patients for LT. Pre-LT, the evaluation of LT patients was not deferred unless for quality-of-life reasons. LDLT was postponed in stable patients.…”

Improving the prognosis before and after liver transplantation: Is muscle a game changer?

“…Autoimmune related liver diseases and cholestatic diseases are rarer indications in Western countries. The epidemiology of LT has changed over the last 20 years since the selection of patients suffering from hepatocellular carcinoma (HCC) with the Milan criteria and the progressive eradication of hepatitis C virus since the universal use of direct-acting antivirals[ 5 ]. MAFLD is probably becoming one of the main indications for LT in parallel with the epidemic of obesity in Western countries.…”