Gut Liver.  2021 Jan;15(1):19-30. 10.5009/gnl19265.

Expanding Indications for Liver Transplant: Tumor and Patient Factors

  • 1Department of Surgery,The University of Hong Kong, Hong Kong, China
  • 2Li Ka Shing Faculty of Medicine,The University of Hong Kong, Hong Kong, China
  • 3Department of Surgery and State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China


During the past few decades, liver transplant has developed from a high-mortality procedure to an almost routine procedure with good survival outcomes. The development of living donor liver transplant has increased the availability of liver grafts, and the scope of indications for liver transplant has been expanding ever since. The aim of this review is to provide an overview of such an expansion of scope. Various criteria have been proposed to expand the eligibility of patients with hepatocellular carcinoma exceeding the Milan criteria for liver transplant. Furthermore, liver transplant is increasingly performed as a treatment modality for cholangiocarcinoma, neuroendocrine liver metastasis and colorectal liver metastasis. The number of elderly patients receiving liver transplant is on the rise. Combined organ transplantation has also been adopted to treat patients with multiple organ failure. Going forward, further development of preoperative noninvasive predictors in tumor, patient and even donor factors is needed to identify patients at risk of poor outcomes and hence optimize patient management.


Liver transplant; Hepatocellular carcinoma; Surgical indication
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