Liver transplantation has significantly improved the prognosis for patients with end-stage liver disease and hepatocellular carcinoma. The indications for liver transplantation have evolved, with a decline in viral hepatitis and an increase in metabolic dysfunction-associated steatotic liver disease. Advancements in surgical techniques, organ preservation, and post-transplant management have expanded the possibilities for liver transplantation, including conditions previously considered contraindications. Ethical dilemmas related to organ scarcity persist, necessitating international collaboration and multidisciplinary approaches. The review highlights emerging indications for liver transplantation, including acute-on-chronic liver failure, acute alcoholic hepatitis, intrahepatic and perihilar cholangiocarcinoma, colorectal liver metastasis, and neuroendocrine tumor liver metastases.

The study investigates the recurrence rate and risk factors of primary sclerosing cholangitis (PSC) after liver transplantation at Padua Hospital from 1993 to 2021. It identifies a 27% recurrence rate of PSC, with factors such as longer cold ischemia time, female donor gender, inflammatory bowel disease reactivation, and hepaticojejunostomy increasing the risk. Despite these recurrences, patient and graft survival rates remain unaffected. The study emphasizes the need for personalized organ allocation and follow-up strategies to mitigate PSC recurrence.

Cholangiocarcinoma (CCA) is a significant concern for patients with primary sclerosing cholangitis (PSC), leading to high mortality rates. PSC-associated CCA (PSC-CCA) often develops within the first few years after PSC diagnosis, with older age, male sex, and concomitant inflammatory bowel disease being key risk factors. The pathogenesis involves complex molecular mechanisms, including inflammatory pathways and genetic alterations. Early detection is challenging due to the insidious clinical presentation, and current surveillance strategies have not significantly improved early detection or survival rates. Novel biomarkers such as microRNAs, gene methylation, and proteomic profiles show promise for future diagnostic and surveillance strategies. The article emphasizes the need for individualized surveillance based on specific risk factors and the integration of new molecular approaches to improve outcomes.