Department of Abdominal Organ Transplantation Surgery, Washington University School of Medicine, St Louis, MO, USA.
Department of Abdominal Organ Transplantation Surgery, Washington University School of Medicine, St Louis, MO, USA; Division of General Surgery, Abdominal Transplantation Section, Barnes-Jewish Hospital, St. Louis, MO, USA.
Chin Clin Oncol. 2021 Feb;10(1):6. doi: 10.21037/cco-20-212. Epub 2020 Dec 14.
Liver transplantation is an exemplar model of complex surgery and the only curative option for patients with end-stage liver disease. Although historically associated with poor outcomes, liver cancer management has also been revolutionised with liver transplantation and in some instances, survival outcomes are comparable to surgical resection. As such, the key elements underpinning the major advances in surgical technique, immunological therapies and allocation policies combined with improved patient and graft survival outcomes have created a huge demand for organ donation. Despite improvements in donor and recipient selection, there is a persistent disparity between organ supply and demand. Candidate wait-list mortality and dropout rates remain problematic and this concern has resulted in increased efforts to expand the donor pool to meet the unmet needs of the population. This is even more challenging when coupled with an ever-growing recipient pool, candidate waiting lists and an ageing population. Over the past two decades, there has been a considerable focus on extended criteria organs, donations after cardiac death and alternative avenues for marginal liver use. With careful donor selection and recipient matching, these livers may help bridge the gap between supply and demand and placate the ever-expanding recipient pool. Here, we present a summary of recent developments by the transplant community addressing the issues of a growing donor and recipient pool.
肝移植是复杂手术的典范模式，也是终末期肝病患者的唯一治愈选择。尽管肝移植历史上与不良结果相关，但肝癌的管理也已发生革命性变化，在某些情况下，其生存结果与手术切除相当。因此，手术技术、免疫治疗和分配政策的主要进步的关键要素，再加上患者和移植物生存结果的改善，导致对器官捐赠的巨大需求。尽管在供体和受体选择方面有所改进，但器官供应与需求之间仍然存在持续的差距。候选者候补名单上的死亡率和脱落率仍然是一个问题，这一担忧导致了扩大供体库以满足人群未满足需求的努力增加。当与不断增长的受者群体、候选者候补名单和老龄化人口相结合时，这一问题更加具有挑战性。在过去的二十年中，人们对扩展标准器官、心脏死亡后捐献和边缘性肝脏使用的替代途径给予了相当大的关注。通过仔细的供体选择和受者匹配，这些肝脏可能有助于弥合供需差距，并满足不断扩大的受者群体。在这里，我们总结了移植界最近为解决不断增长的供体和受者群体问题所做的努力。
