Beyond allocation: Comprehensive management of liver transplant candidates on the waiting list

Liver transplantation is the definitive treatment for selected patients with end-stage liver disease and hepatocellular carcinoma, yet organ scarcity exposes candidates to substantial mortality and clinical deterioration while awaiting transplantation.The waiting period should therefore be regarded as a dynamic phase in which disease severity, transplantability, and potentially modifiable risk factors require repeated assessment.This narrative review examines waitlist outcomes and contemporary allocation models, including the model for end-stage liver disease, model for endstage liver disease-sodium, model for end-stage liver disease 3.0, and the genderequity model for liver allocation.It also discusses waitlist-specific management of portal vein thrombosis and hepatocellular carcinoma, as well as the potential role of transjugular intrahepatic portosystemic shunt placement as a bridge to transplantation.Particular attention is given to malnutrition, sarcopenia, frailty, and multimodal prehabilitation, which are incompletely captured by conventional allocation scores but strongly influence waitlist and post-transplant outcomes.Current evidence supports individualized, multidisciplinary follow-up aimed not only at updating allocation priority but also at preserving transplantability.Future studies should define risk-adapted surveillance schedules and determine whether targeted interventions improve survival, reduce delisting, and enhance recovery after transplantation.