**7. Conclusion and perspectives**

The hope of finding new surgical and pharmacological therapeutic applications provides a strong impetus to identify the mechanisms responsible for the failure of fatty livers. We must continue conducting researches attempting to improve the outcomes of LT using fatty liver grafts. Before a complete definition of a successful therapeutic strategy based on regulating hepatic I/R injury is stated, several additional points need to be addressed. The effects of the new potential protective strategies (TMZ, AICAR, RAS modulators, PI3K and ERK1/2 modulators, anti-apoptotic strategies, omega-3 PUFA, adiponectin, RBP4 and PC) on the pathways involved in the inflammatory process and lipid metabolism have only just been mapped. The success of these protective strategies might depend on the surgical procedure. Moreover, the response of different type of liver to these treatments might differ and involve different signal transduction pathways that are at present marginally understood. Whether the above-mentioned approaches can be translated into as viable options in the clinical practice remain unknown, but further researches are required to optimize the their use (e.g. dose, pharmacokinetics…etc). Such approaches have the potential to increase the number of organs suitable for transplantation, since they may improve the outcomes of marginal grafts that would not otherwise have been used.

#### **8. Acknowledgment**

Elias-Miró M. and Jiménez-Castro M.B. contributed equally to this work

#### **9. References**


One disadvantage of PC is that it requires a period of pre-ischemic manipulation for organ

The hope of finding new surgical and pharmacological therapeutic applications provides a strong impetus to identify the mechanisms responsible for the failure of fatty livers. We must continue conducting researches attempting to improve the outcomes of LT using fatty liver grafts. Before a complete definition of a successful therapeutic strategy based on regulating hepatic I/R injury is stated, several additional points need to be addressed. The effects of the new potential protective strategies (TMZ, AICAR, RAS modulators, PI3K and ERK1/2 modulators, anti-apoptotic strategies, omega-3 PUFA, adiponectin, RBP4 and PC) on the pathways involved in the inflammatory process and lipid metabolism have only just been mapped. The success of these protective strategies might depend on the surgical procedure. Moreover, the response of different type of liver to these treatments might differ and involve different signal transduction pathways that are at present marginally understood. Whether the above-mentioned approaches can be translated into as viable options in the clinical practice remain unknown, but further researches are required to optimize the their use (e.g. dose, pharmacokinetics…etc). Such approaches have the potential to increase the number of organs suitable for transplantation, since they may

improve the outcomes of marginal grafts that would not otherwise have been used.

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**7. Conclusion and perspectives** 

**8. Acknowledgment** 

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