Perspective Chapter: The Future of Liver Transplantation

Liver transplantation (LT) has evolved significantly since its inception in 1963, transitioning from an experimental procedure to a life-saving intervention for patients with end-stage liver disease and selected liver cancers. Through these years, advances in surgical techniques, graft preservation, and postoperative care have resulted in 1-year survival rates exceeding 90%. Despite the increase in 1 year graft function, issues like organ shortage and long-term complications remain major challenges. This chapter explores cutting-edge innovations that aim to improve LT outcomes and address these limitations. Recent developments in precision medicine, artificial intelligence (AI), and other technological breakthroughs have enhanced all stages of LT, from organ allocation to post-operation management. Other major improvements include advancements in the field of immunosuppression protocols, with studies now supporting drug minimization and withdrawal in selected patients. Innovations in the field of diagnosis aim to improve sensitivity and specificity, while also focusing on the development of non-invasive diagnostic methods with clinical applicability. Furthermore, the usage of marginal grafts has led to emerging preservation technologies, such as normothermic and hypothermic machine perfusion. Collectively, these innovations mark a transformative era for LT, moving toward safer, more personalized, and sustainable transplantation practices.