Without social change or new therapies, alcohol-associated liver disease (ALD) and metabolic dysfunction–associated steatotic liver disease (MASLD; formerly called nonalcohol-related fatty liver disease) will likely drive future demand for liver transplantation, according to a review article. First performed in people 60 years ago, “liver transplantation … will probably remain the treatment of last resort for life-threatening liver disease,” write the authors. “However, it remains a demanding therapy for patients, providers, and society.”
“Better tools for identifying patients with ALD who are likely to recover without transplantation, better instruments for predicting future drinking, and studies of alcohol use disorder in patients with ALD will advance the care of patients,” the authors conclude. “A straightforward improvement would be for centers to be more candid with patients and their families about the process of selection for transplantation. We hope that the continuing need for immunosuppression will stimulate the development of methods to induce selective tolerance in patients with liver allografts. The discrepancy between the supply of and demand for donor livers will probably persist for the foreseeable future. Machine perfusion of donor livers … may offer the best hope for increasing the donor liver supply through dynamic assessment of allograft viability and the application of therapies to recondition the allograft before implantation. We await breakthroughs that might come through the use of xenografts or tissue engineering.”