REGULATORY ISSUES AND QUALITY IMPROVEMENT: Edited by Michael L. VolkEvaluation and selection of the liver transplant candidate: updates on a dynamic and evolving processKriss, Michaela; Biggins, Scott W.b,cAuthor Information aDivision of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado bDivision of Gastroenterology and Hepatology cCenter for Liver Investigation Fostering discovEry (C-LIFE), University of Washington, Seattle, Washington, USA Correspondence to Scott W. Biggins, MD, MAS, Division of Gastroenterology and Hepatology, University of Washington, 1959 NE Pacific Street, Box 356175, Seattle, WA 98195, USA. E-mail: [email protected] Current Opinion in Organ Transplantation: February 2021 - Volume 26 - Issue 1 - p 52-61 doi: 10.1097/MOT.0000000000000829 Buy Metrics Abstract Purpose of review Although conceptually unchanged, the evaluation and selection of the liver transplant candidate has seen significant recent advances. Expanding criteria for transplant candidacy, improved diagnostics for risk stratification and advances in prognostic models have paralleled recent changes in allocation and distribution that require us to revisit core concepts of candidate evaluation and selection while recognizing its now dynamic and continuous nature. Recent findings The liver transplant evaluation revolves around three interrelated themes: candidate selection, donor selection and transplant outcome. Introduction of dynamic frailty indices, bariatric surgery at the time of liver transplant in obese patients and improved therapies and prognostic tools for hepatobiliary malignancy have transformed candidate selection. Advances in hypothermic organ preservation have improved outcomes in marginal donor organs. Combined with expansion of hepatitis C virus positive and split donor organs, donor selection has become an integral part of candidate evaluation. In addition, with liver transplant for acute alcohol-related hepatitis now widely performed and increasing recognition of acute-on-chronic liver failure, selection of critically ill patients is refining tools to balance futility versus utility. Summary Advances in liver transplant candidate evaluation continue to transform the evaluation process and require continued incorporation into our clinical practice amidst a dynamic backdrop of demographic and policy changes. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.