Current status and actual need for pediatric liver transplantation in Southern Vietnam

Abstract

Liver transplantation (LT) has considerably improved the outcome of patients with end-stage liver disease, especially in children. The first pediatric LT in Vietnam was performed in 2004. To assess the current need for pediatric LT in Southern Vietnam, a total of 280 patients with chronic liver disease followed at Children's Hospital 2 (Ho Chi Minh City), the only pediatric LT center in this region, were evaluated from January 2009 to June 2014. Sixty-seven patients satisfied criteria for LT but only one transplant surgery occurred since 2009. Parental consent for LT was obtained only in 28.4% of patients. The main reasons for the small number of LTs were financial costs, far distance from home, lifelong follow-up and treatment, and shortage of organ donors. We conclude that the current need for pediatric LT in Southern Vietnam is high. Efforts should be made to develop the liver transplant program in this developing country.

Examining need and capacity for the development of a pediatric liver transplantation program in Kenya

“…Typically, a Pediatric End‐Stage Liver Disease (PELD) score is assigned, and PLT is performed according to severity. For example, in Southern Vietnam, children qualified for consideration for PLT with a PELD score of 10 or greater 46 . However, if we extrapolate our estimated need for PLT for BA to include all PLD etiologies that are amenable to PLT in the total population of Kenya, the all‐cause need for PLT in Kenya is higher than the estimated 1–2 transplants per million children per year.…”

“…Comparatively, the cost for the same procedure is much lower in LMICs. In Southern Vietnam, the cost was an estimated US $13 767, 46 and in South Africa, the cost over the first 3 months was an estimated US $20 000 47 . The approximate cost for PLT in Kenya may be estimated from these values.…”

“…BA is the most common worldwide indication for PLT 13 . In other LMICs, BA was the main indication for PLT consideration: 80% in Vietnam, 54% in South Africa, 67% in Indonesia, and 42% in Colombia 38,39,46,47 . Furthermore, the treatment for BA is definitively surgical – the vast majority of children will undergo Kasai portoenterostomy, and approximately 20–40% will continue to have liver dysfunction and eventually require PLT 13,48 .…”

“…49 The cost of an LT in the United States is over US $500000. 46 Comparatively, the cost for the same procedure is much lower in LMICs. In Southern Vietnam, the cost was an estimated US $13 767, 46 and in South Africa, the cost over the first 3 months was an estimated US $20 000.…”

“…LT programs have been successfully established in other LMICs with the support of HIC transplant programs with good outcomes, improving access to surgical care for children globally. 32,38,39,46,[55][56][57][58] The eventual selfsufficiency of the de novo LT program should be the foremost goal. 37…”