Liver Transplantation in Developing Countries

Öztürk, Begüm; Muhammad, Haris; Gürakar, Merve; Aslan, Alperen; Gürakar, Ahmet; Dao, Doan Y.

doi:10.14744/hf.2022.2022.0014

Cited by 9 publications

(16 citation statements)

References 54 publications

(187 reference statements)

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“…LT centres in the LMICs face major challenges with a lack of adequate facilities, organization and trainings to improve their capabilities. Across many countries, there is a lack of government support in developing organ donation legislation, establishing successful and workable organ donation networks, lack of investment in training of human resources and upgradation of hospital capabilities [14,17,18]. The lack of legislation regarding the use of deceased-donor livers for transplantation limits transplant surgeries in LMICs [8].…”

Section: Challenges To Liver Transplantation In Lmicsmentioning

confidence: 99%

Challenges of liver transplantation programs in low‐ and middle‐income countries: An experience from Sri Lanka

Jayarathna,

Dassanayake,

Dorji

et al. 2024

Public Health Challenges

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Liver diseases lead to 1.3 million deaths per year around the world, the majority of which are secondary to cirrhosis. In the management of liver diseases in chronic and acute conditions, liver transplant (LT) plays a major role in improving the survival and quality of life of patients. LT programmes require the technical capabilities in performing the pre‐transplant evaluation, transplant surgery and post‐transplant care supported by adequate infrastructure and a set of trained teams. Globally, there were 28,000 deceased donor LTs, and 14,000 living donor LTs were performed in 2021. In the South Asia region, India, Pakistan and Sri Lanka conducted 2998 LTs in 2021. Many countries report sociocultural, religious and legislative barriers to acquiring adequate donor livers. We describe the challenges in LT programmes in low‐ and middle‐income countries and experiences from Sri Lanka. Sri Lanka carried out its first LT in 2010, and the service is provided free of charge in the state health sector. In Sri Lanka, the common indications for LT in adults are non‐alcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma and alcoholic liver disease. In children, the indications are biliary atresia, hepatocellular carcinoma and Wilson disease. The common challenges include a lack of an adequate number of doctors and post‐transplant team members, a low number of organ donors and a long waiting list, all of which can be disadvantageous for transplant programmes. To continue providing LT services, there is a need to adopt multimodal strategies in the areas of providing additional skills training to the operating team and promoting organ donation culture in the background of supportive organ donation legislation. With the adoption of the national strategic plan for organ, tissue and cell transplantation, the country hopes to strengthen its capacity of providing transplant services to its people.

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Section: Challenges To Liver Transplantation In Lmicsmentioning

confidence: 99%

Challenges of liver transplantation programs in low‐ and middle‐income countries: An experience from Sri Lanka

Jayarathna,

Dassanayake,

Dorji

et al. 2024

Public Health Challenges

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“…Although there are reports that Eastern population when compared with the Western have a higher percentage of body fat for a specified BMI (different BMI cutoff compared with west), higher rates of hepatic macrosteatosis, lean (nonobese) nonalcoholic fatty liver disease, lower liver regenerative potential, different transplant indications, and recipient acuity, there is currently no evidence to suggest that the donor ethnicity has an impact on SFSS in the recipient. 2,[74][75][76] RECIPIENT SELECTION…”

Section: Type Of Surgery (Open Versus Lap Versus Robotic)mentioning

confidence: 99%

Preventing Small-for-size Syndrome in Living Donor Liver Transplantation: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference

Hakeem,

Mathew,

Aunés

et al. 2023

Transplantation

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Small-for-size syndrome (SFSS) is a well-recognized complication following liver transplantation (LT), with up to 20% developing this following living donor LT (LDLT). Preventing SFSS involves consideration of factors before the surgical procedure, including donor and recipient selection, and factors during the surgical procedure, including adequate outflow reconstruction, graft portal inflow modulation, and management of portosystemic shunts. International Liver Transplantation Society, International Living Donor Liver Transplantation Group, and Liver Transplant Society of India Consensus Conference was convened in January 2023 to develop recommendations for the prediction and management of SFSS in LDLT. The format of the conference was based on the Grading of Recommendations, Assessment, Development, and Evaluation system. International experts in this field were allocated to 4 working groups (diagnosis, prevention, anesthesia, and critical care considerations, and management of established SFSS). The working groups prepared evidence-based recommendations to answer-specific questions considering the currently available literature. The working group members, independent panel, and conference attendees served as jury to edit and confirm the final recommendations presented at the end of the conference by each working group separately. This report presents the final statements and evidence-based recommendations provided by working group 2 that can be implemented to prevent SFSS in LDLT patients.

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“…Although Western countries (North America and Europe) lead the LT practice in terms of case volume and organ procurement rates, LDLT remains a small portion of all LT in the area. [ 3 ] It accounted for only 6% of LTs in the USA, 15.6% in Canada, 2.5% in Italy, and 1 reported case in Spain in 2021. [ 4 ] In contrast, select countries across Asia (75% of all LT in South Korea, 91% in Turkey, 84% in Saudi Arabia, 84% in Japan, and 81% in India) have heavily relied on living liver donors.…”

Section: Global Practices and Perceptionsmentioning

confidence: 99%

Practice patterns and considerations in liver transplantation from living donors with high BMI: A review

Samaha

2023

Hepatology Forum

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Living Donor Liver Transplantation (LDLT) is a valuable solution to the shortage of donor organs for patients with end-stage liver disease. However, the eligibility of obese donors for LDLT remains a subject of debate. This literature review explores global practices and perceptions of LDLT, identifies donor eligibility criteria, and discusses special considerations and ethical caveats. The review highlights the need for standardized guidelines for donor selection, considering the global distribution of Body mass index and variations in population-specific criteria. It also emphasizes the importance of non-invasive testing and pre-operative optimization of liver steatosis for select obese donors. Furthermore, the review examines the outcomes and complications associated with obese donors in LDLT. The findings of this review contribute to the ongoing discussion on the inclusion of obese donors in LDLT and provide insights for future research and guideline development.

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Liver Transplantation in Developing Countries

Cited by 9 publications

References 54 publications

Challenges of liver transplantation programs in low‐ and middle‐income countries: An experience from Sri Lanka

Challenges of liver transplantation programs in low‐ and middle‐income countries: An experience from Sri Lanka

Preventing Small-for-size Syndrome in Living Donor Liver Transplantation: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference

Practice patterns and considerations in liver transplantation from living donors with high BMI: A review

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