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Alcohol\u2010related liver disease and metabolic dysfunction\u2010associated steatotic liver disease have become leading indications for adult liver transplantation in Australia and New Zealand. Transplant recipients are increasingly older and medically complex, necessitating multi\u2010disciplinary assessment including evaluation of frailty. Indications for liver transplantation have expanded to include selected patients with severe alcohol\u2010related hepatitis, acute\u2010on\u2010chronic liver failure, extended\u2010criteria hepatocellular carcinoma and other highly selected non\u2010resectable liver malignancies including colorectal liver metastases and cholangiocarcinoma. In parallel, donor utilisation has evolved, with increasing use of expanded\u2010criteria donors and donation after circulatory determination of death. Machine perfusion technologies are increasingly used in Australia to optimise marginal liver grafts and minimise waitlist mortality. Having an awareness of these evolving indications, recipient complexity and donor optimisation strategies is essential to support timely liver transplantation referral, improve inter\u2010disciplinary understanding, allow equitable access and provide appropriate stewardship of limited donor organs.<\/jats:p>","DOI":"10.5694\/mja2.70276","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T12:44:01Z","timestamp":1787661841000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Changing Indications for Adult Liver Transplantation in Australia: A Narrative Review"],"prefix":"10.5694","volume":"224","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3977-0382","authenticated-orcid":false,"given":"Fadak","family":"Mohammadi","sequence":"first","affiliation":[{"name":"Flinders Medical Centre  Adelaide South Australia Australia"},{"name":"Flinders University  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8054-5745","authenticated-orcid":false,"given":"Alan J.","family":"Wigg","sequence":"additional","affiliation":[{"name":"Flinders Medical Centre  Adelaide South Australia Australia"},{"name":"Flinders University  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Liu","sequence":"additional","affiliation":[{"name":"Royal Prince Alfred Hospital  Sydney New South Wales Australia"},{"name":"Faculty of Medicine and Health University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6374-1525","authenticated-orcid":false,"given":"Simone I.","family":"Strasser","sequence":"additional","affiliation":[{"name":"Royal Prince Alfred Hospital  Sydney New South Wales Australia"},{"name":"Faculty of Medicine and Health University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.25859"},{"key":"e_1_2_11_3_1","volume-title":"35th Annual Report ANZLITR. 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