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Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 27, 2023; 15(3): 321-352
Published online Mar 27, 2023. doi: 10.4254/wjh.v15.i3.321
Main factors influencing long-term outcomes of liver transplantation in 2022
Elisa Fuochi, Lorenzo Anastasio, Erica Nicola Lynch, Claudia Campani, Gabriele Dragoni, Stefano Milani, Andrea Galli, Tommaso Innocenti
Elisa Fuochi, Lorenzo Anastasio, Erica Nicola Lynch, Gabriele Dragoni, Stefano Milani, Andrea Galli, Tommaso Innocenti, Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
Claudia Campani, Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
Gabriele Dragoni, Department of Medical Biotechnologies, University of Siena, Siena 53100, Italy
Author contributions: Fuochi E and Anastasio L performed the bibliographic search and drafted the initial manuscript; Innocenti T and Lynch EN re-screened the search results; Lynch EN provided English language revision as a native speaker; Lynch EN, Campani C, Dragoni G, Milani S, Galli A, and Innocenti T revised the article critically for important intellectual content; and all Authors approved the final version of the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tommaso Innocenti, MD, Research Fellow, Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale G. B. Morgagni, 50, Florence 50134, Italy. tommaso.innocenti@unifi.it
Received: October 18, 2022
Peer-review started: October 18, 2022
First decision: November 14, 2022
Revised: November 24, 2022
Accepted: February 22, 2023
Article in press: February 22, 2023
Published online: March 27, 2023
Abstract

Liver transplant (LT) outcomes have markedly improved in the recent decades, even if long-term morbidity and mortality are still considerable. Most of late deaths are independent from graft function and different comorbidities, including complications of metabolic syndrome and de novo neoplasms, seem to play a key role in determining long-term outcomes in LT recipients. This review discusses the main factors associated with late mortality and suggests possible strategies to improve long-term management and follow-up after liver transplantation. In particular, the reduction of drug toxicity, the use of tools to identify high-risk patients, and setting up a multidisciplinary team also for long-term management of LT recipients may further improve survival after liver transplantation.

Keywords: Alcohol, Liver transplantation, Long term survival, Metabolic syndrome, Renal dysfunction, Therapy adherence

Core Tip: Survival after liver transplantation has increased in the last decades due to an improvement in early post-transplantation outcomes, underlining the need to shift the focus towards long-term outcomes. We herein discuss the main factors related to long-term morbidity and mortality in liver transplant recipients and outline the main management suggestions and recommendations to improve long-term outcomes.