Featuring: Josh Levitsky, MD, MS
The field of liver transplantation is at an exciting, challenging crossroad. The last two decades have seen a steady growth in numbers of patients waitlisted and transplanted; outcomes have been preserved thanks to advances in medical, surgical and multidisciplinary care.
However, several unique challenges remain, and clinicians and investigators are working to address them. In the last 20 years, our liver transplant population has gotten older with more comorbidities that need specialized diagnostic assessments and management strategies to optimize survival and quality of life pre- and post-transplant. Frailty assessments are now standard at transplant centers and aid decisions to move forward with transplantation and/or highlight the need for physical therapy, nutrition and psychological support.
Metabolic-associated steatohepatitis and alcohol-associated steatohepatitis are by far the leading causes of liver failure leading to transplantation. Both can recur after transplantation unless interventions are implemented soon after the transplant to address issues of recurrence of obesity, diabetes, other cardiovascular risks and alcohol use. While early outcomes are excellent, the long-term survival of liver transplant recipients has not changed significantly in the last 20 years, owing to the occurrence of malignancy, kidney failure, cardiovascular events, infection and recurrent graft fibrosis.
All of these issues need more attention to enhance long-term survival and quality of life for our patients. Minimizing or withdrawing immunosuppressive therapy without causing rejection may be part of the answer to limit these complications — several studies are underway to assess the risks and benefits of these interventions.
As president of the American Society of Transplantation (ATS), I am dedicated to advancing transplantation. As a hepatologist, I am dedicated to advancing the field of liver transplantation.
AST is working with other liver societies to advance the field and work together for our clinicians, patients donors and their families.
Josh Levitsky, MD, MS, Professor of Gastroenterology and Hepatology, Organ Transplantation, Medical Education,
Chief, Division of Hepatology
Northwestern Medicine welcomes the opportunity to collaborate with you in caring for your patients.