Prof. Diethard Monbaliu

Prof. Diethard Monbaliu is one of Belgium's leading abdominal transplant surgeons and a key figure in European liver transplantation, holding a senior professorial appointment at KU Leuven (Catholic University of Leuven) and practicing at UZ Leuven—one of Belgium's premier university hospitals and a major European center for organ transplantation. The liver transplant program at UZ Leuven is one of the most active in Belgium and operates within Eurotransplant, the international organ exchange organization covering eight European countries.

With over 25 years of specialized experience, Prof. Monbaliu has performed hundreds of liver transplantations—from both deceased and living donors—covering the full clinical spectrum from acute liver failure to end-stage chronic liver disease, hepatocellular carcinoma within Milan criteria, and rare metabolic conditions causing progressive liver damage. His surgical practice is complemented by a deep commitment to research in organ preservation, which addresses one of the most pressing practical problems in transplantation: how to extend the viability and improve the quality of donor organs that would otherwise be unsuitable for transplantation.

Prof. Monbaliu is particularly recognized for his research and clinical implementation of normothermic machine perfusion (NMP) of the liver—a technology in which a retrieved donor liver is connected to a perfusion circuit that maintains it at body temperature, supplying oxygen and nutrients, allowing the organ to resume normal metabolic function ex vivo. This allows transplant surgeons to assess liver viability over hours before making the decision to transplant, dramatically reducing the risk of early graft failure from marginal donor organs.

His multidisciplinary approach integrates closely with the hepatology and critical care teams at UZ Leuven to ensure that patients are optimally prepared for transplantation and supported through recovery. He regularly receives patients referred from across Belgium and neighboring countries who require liver transplant evaluation.

Prof. Monbaliu completed his medical degree at KU Leuven, followed by surgical residency and subspecialty training in abdominal surgery and transplantation at UZ Leuven, where he trained under leading Belgian transplant surgeons who established the Leuven program's international reputation. His PhD dissertation, awarded by KU Leuven, focused on ischemia-reperfusion injury in the liver—the cascade of cellular damage that occurs when blood flow is restored to an ischemic organ—and the role of protective strategies including pharmacological and machine perfusion interventions. He completed visiting fellowship training at major liver transplant centers in France and the United States, gaining exposure to high-volume programs and emerging techniques in marginal donor utilization. He has subsequently trained numerous surgical residents and fellows at UZ Leuven, and holds a professorship in surgery at KU Leuven.

Prof. Monbaliu's operative practice covers the full technical scope of liver transplantation. For deceased-donor liver transplantation, he performs both standard and complex implantation procedures including split liver transplantation—where a single deceased-donor liver is divided to provide grafts for two recipients, typically an adult and a child—significantly increasing the effective supply of transplantable organs. He is expert in the management of high-risk donor livers including steatotic (fatty) livers, older donors, and donation after circulatory death (DCD) organs, for which machine perfusion assessment is particularly valuable.

For living-donor liver transplantation, he participates in the procurement of right or left lobe grafts from carefully selected healthy donors, minimizing donor risk while providing an optimal graft for the recipient. His machine perfusion expertise includes both hypothermic oxygenated machine perfusion (HOPE), which is applied during cold storage, and normothermic machine perfusion (NMP), which is increasingly used to reconstitute marginal livers to transplantable quality. He also applies normothermic regional perfusion (NRP) in the context of DCD donation, to assess and rehabilitate livers in situ before procurement. Post-transplant, he participates in managing biliary and vascular complications in collaboration with interventional radiologists and endoscopists.

Prof. Monbaliu has authored or co-authored over 150 peer-reviewed papers focusing on liver transplantation outcomes, machine perfusion technology, and ischemia-reperfusion injury. His publications appear in Liver Transplantation, Hepatology, Transplantation, and the American Journal of Transplantation—the field's leading journals. His research on normothermic machine perfusion of DCD livers has contributed to the evidence base that has led multiple European and international transplant centers to adopt NMP as a clinical tool for marginal donor assessment. He has contributed to European consensus statements on machine perfusion technology in liver transplantation, helping standardize indications, protocols, and viability criteria across Eurotransplant countries. He has been principal investigator on Belgian Science Policy (BELSPO) and KU Leuven Research Fund-supported projects in organ preservation, and participates in international ESOT working groups on machine perfusion.

UZ Leuven's transplant program regularly evaluates patients from other European countries and internationally who have been referred for liver transplant assessment or who are seeking a second opinion on their transplant candidacy. The hospital has an international patient office with multilingual support and experience coordinating with foreign health insurance systems. Prof. Monbaliu consults in Dutch, French, and English. EU patients can access care at UZ Leuven under EU cross-border healthcare provisions, and the Leuven transplant center's Eurotransplant membership means that patients listed at UZ Leuven have access to a broader organ pool than any single national system could provide. Non-EU patients are accommodated on a private basis with full cost and logistics information provided before arrival. Video consultations are available for initial case review and for post-transplant follow-up of patients who have returned to their home country.

Prof. Monbaliu received the ESOT (European Society for Organ Transplantation) Young Investigator Award, one of European transplantation's most prestigious early-career honors, for his innovative research in organ preservation and ischemia-reperfusion injury that demonstrated significant translational potential. KU Leuven awarded him its Technology Award for the development and clinical translation of machine perfusion protocols for marginal donor liver assessment—a rare honor recognizing both scientific rigor and practical clinical impact. The Belgian Transplantation Society has recognized him with its Research Prize for contributions to advancing liver transplantation science in Belgium and internationally. He has served as session chair and invited speaker at ELITA, ESOT, and the International Liver Transplantation Society (ILTS) congresses, and participates in ESOT guideline committees on machine perfusion and extended criteria donor utilization.