Guideline Update: Adult Liver Transplantation-Guideline Update: Adult Liver Transplantation

Video Transcription

Video Summary

In this interview, Drs. Helen Tay and Thomas Shiano discuss the new 2025 ASLD-AST guidelines on adult liver transplantation, focusing on graft-related complications. Key updates include the endorsement of machine perfusion techniques to improve donor organ utilization and reduce early graft dysfunction. Immunosuppression strategies have evolved, with induction agents being less emphasized, steroid use minimized especially in autoimmune hepatitis, and early introduction of mTOR inhibitors showing benefits, particularly in HCC patients within Milan criteria. MRCP is highlighted as a reliable, non-invasive first-line imaging tool for biliary complications, alongside updated guidance on using metal vs. plastic stents. Monitoring immunosuppression remains challenging, with no definitive biomarkers yet; liver biopsy is advised if tapering is considered. The guidelines discuss safe use of hepatitis C and hepatitis B infected donor organs to expand the pool, emphasizing antiviral prophylaxis and patient counseling. For patients transplanted due to alcohol-related liver disease, a multidisciplinary follow-up approach promoting abstinence and monitoring relapse is recommended.

Keywords

2025 ASLD-AST guidelines

adult liver transplantation

machine perfusion

immunosuppression strategies

MRCP biliary imaging

hepatitis infected donor organs