The Revolution in Indication for Liver Transplantation: Will Liver Metastatic Disease Overcome the End-Stage Liver Disease in the Next Future?

Abstract

Indications for liver transplantation (LT) have constantly been evolving during the last few decades due to a better understanding of liver diseases and innovative therapies. Likewise, also the underlying causes of liver disease have changed. In the setting of transplant oncology, recent developments have pushed the boundaries of oncological indications for LT outside hepatocellular carcinoma (HCC), especially for secondary liver tumors, such as neuroendocrine and colorectal cancer. In the next years, as more evidence emerges, LT could become the standard treatment for well-selected metastatic liver tumors. In this manuscript, we review and summarize the available evidence for LT in liver tumors beyond HCC with a focus on metastatic liver malignancies, highlighting the importance of these new concepts for future implications.

Clinical outcomes after transplantation of domino grafts or standard deceased donor livers: a systematic review and meta‐analysis

“…Notably, the reports in our study focused only on FAP; therefore, it was not possible to explore the impact of DLT on waiting list times when considering other indications, such as other metabolic disorders. At present, while there is a constant shortage of transplantable organs, the number of indications for LT is expanding, especially for secondary liver tumors and metastases 21 . In the future, DLT could be a compelling option to expand donor pool and enable transplantation of patients even with biologically unfavorable liver tumors or metastatic diseases, who might have limited access to organs, especially in countries with longer waitlist times and where the number of deceased donors is limited 22–24 .…”

“…At present, while there is a constant shortage of transplantable organs, the number of indications for LT is expanding, especially for secondary liver tumors and metastases. 21 In the future, DLT could be a compelling option to expand donor pool and enable transplantation of patients even with biologically unfavorable liver tumors or metastatic diseases, who might have limited access to organs, especially in countries with longer waitlist times and where the number of deceased donors is limited. [22][23][24] In our study, we were able to demonstrate similar long-term recipient survival rates between DLT and DDLT.…”

Moving Forward to New Trends in Liver Transplantation

“…On top of this, the recent advances in transplant oncology showed that LT can be an effective treatment for other types of primary and secondary liver cancers beyond hepatocellular carcinoma. These types of evidence could change the trends in indication for LT [2].…”