**6. References**


Since the first transplantation was performed much progress has been made in the field of OLT. Indications for liver transplant have evolved to include previously contraindicated conditions such as those with hepatocellular carcinoma and alcohol-related liver disease. All but one (active sepsis outside the biliary system) contraindication to OLT has been eliminated. As a result, more than 200,000 patients have been transplanted, many with excellent long-term success. With indications to transplantation increasing and

The future of liver transplantation will be no less challenging for its practitioners. The main challenge is the shortage of organs, and many strategies are in place to address this problem. In the near future, immunologic discoveries will allow for an immunosuppression-free state of many recipients. This will guarantee better quality of life and similar survival expectancy as non-transplanted patients. Regenerative medicine technology applied to liver transplantation has the potential to meet the two major needs: namely, the identification of a potentially inexhaustible source of livers and an immunosuppression-free state. In the ideal scenario, livers will be manufactured from autologous cells with no need for anti-rejection

Bonaccorsi-Riani E., et al. (2010). Liver transplantation and neuroendocrine tumours: lessons

Burke A, Lucey MR. (2004). Non-alcoholic fatty liver disease, nonalcoholic steatohepatitis and orthotopic liver transplantation. Am J Transplant, 4, 5, 686–693.

Demetriou AA, Brown RS, Busuttil RW et al. (2004). Prospective, randomized, multicenter,

Ellis AJ, Hughes RD, Wendon JA, Dunne J, Langley PG, Kelly JH, Gislason GT, Sussman

Foss A, Adam R, Dueland S. (2011) Liver transplantation for colorectal metastases: revisiting

Kayler LK, Rasmussen CS, Dykstra DM, et al. (2003). Liver transplantation in children with metabolic disorders in the United States. Am J Transplant, 3, 2003, 334-339. Lerut J., Mazza D.,Van Leeuw V.,Laterre P.F.,Donataccio M.,De Ville de Goyet J. et al. (1997).

Lerut J et al. (1998). Liver transplantation and HBV-related disease: adequate immuno-

CDC (2007). Centers for Disease Control and Prevention Database.

acute liver failure. Hepatology, 24, 1996, 1446-51. European Liver Transplant Registry. Available at: www.ELTR.org. Eurostat (2007). Eurostat's Harmonised Regional Statistical Database.

the concept Transplant Int. 23, 2011, 679-685.

patients. Transplant Int 10, 1997, 125-132.

Hepatol 30, 1998, 706-714.

from a single centre experience and from the literature review Transplant Int 23,

controlled trial of bioartificial liver in treating acute liver failure. Ann Surg, 239,

NL, Williams R. (1996). Pilot-controlled trial of extracorporeal liver assist device in

Adult Liver transplantation and abnormalities of splanchnic veins: experience in 53

prophylaxis and delta co-infection as major determinants of long-term prognosis. J

contraindications waning, many more patients will be transplanted in the future.

**5. Conclusion** 

therapy.

**6. References** 

2010, 668-678.

2004, 660.


**11** 

*USA* 

**Potential of Mesenchymal Stem Cells** 

Christopher D. Porada and Graça D. Almeida-Porada

A wide variety of diseases, including cirrhosis, unresectable hepatic malignancy, ischemia, metabolic and auto-immune disorders, and hepatitis, whether caused by viral agents or drugs/toxins, can trigger hepatic insufficiency and failure, a life-threatening situation for which liver transplantation is the only definitive therapy [1-4]. Over 16,000 patients are currently awaiting the availability of a liver from a compatible donor [5], and many of these patients will die without ever receiving a transplant, due to the current shortage of available donor organs [6]. Furthermore, even when a patient is fortunate enough to find a compatible donor and receive a liver transplant, several factors can still thwart the ultimate success of this procedure. Operative damage, immune rejection towards the new organ, relapse of the pre-existing liver disease, and life-long side effects due to immunosuppression are among the most common complications [7, 8]. Furthermore, after liver transplantation, several longterm morbidities can arise, such as cardiovascular and retinal complications, lymphoproliferative disorders, and chronic renal failure [8-10]. Additionally, it is anticipated that the number of patients in need of liver transplantation will increase in the next decade, due to the obesity epidemic and the higher incidence of Hepatitis C infection. Therefore, new therapeutic approaches that can eliminate the need for partial or complete liver

A valuable alternative to entire or partial liver transplantation is the delivery of cells capable of restoring normal organ physiology [11-19]. The use of cell therapy possesses several inherent advantages over organ transplantation: the procedure could be performed in a much less invasive way, the purified cell populations may be less immunogenic [20], and

Hepatocyte transplantation has been considered one of the most promising alternatives to liver transplantation, as these cells offer the benefit of being fully functional and are therefore able to quickly replace damaged hepatocytes upon delivery [22]. Also, the ability to cryopreserve and store hepatocytes gives the advantage of having a source of cells available when required. However, accessibility of hepatocytes at the required numbers for clinical intervention is still problematic, as human livers are required for their isolation, and

**1. Introduction** 

transplantation are urgently needed.

the use of autologous cells could be implemented [21].

**for Liver Regeneration** 

*Department of Regenerative Medicine,* 

*Wake Forest Institute for Regenerative Medicine,* 

Melisa Andrea Soland,

medicine as applied to solid organ transplantation: current status and future development. Transpl Int, 24, 2011, 223-232.

