Optimizing the liver transplant candidate

The purpose of this review is to highlight common and best practices in liver transplant evaluation and management, particularly on how to best optimize a patient to become a successful recipient. There is an increasing armamentarium of pharmacologic, procedural, and behavioral interventions that has grown in body of evidence and use in clinical practice to best prepare patients for liver transplant. This includes tools in the management of common decompensations in liver disease, such as hepatic encephalopathy or ascites, as well as associated medical comorbidities that are also encountered in the general population. Aside from management of decompensations, a holistic approach to pre-operative care, including prehabilitation, is becoming increasingly more important to improve sarcopenia, frailty, and quality of life through an exercise program and nutritional modifications. Social determinants of health have become an increasingly recognized barrier to equitable LT access and have garnered increasing attention in the last several years. The road to liver transplantation is a multi-disciplinary patient-centered journey. The complications of decompensated disease require thoughtful decision making as it pertains to management and is a careful balance to avoid the creation of iatrogenic complications which can impact clinical stability and candidacy. Further investment in the management of behavioral modifications and lifestyle is an essential part of the treatment process.