Liver transplantation in China: problems and their solutions

Area of Science:

• Hepatology
• Transplantation Surgery
• Gastroenterology

Background:

• Liver transplantation in China has seen significant growth over the past decade, with 1-year survival rates reaching 80% in leading centers.
• Despite advancements, challenges remain, including managing recipients with hepatocellular carcinoma (HCC), hepatitis B recurrence, long-term postoperative care, and donor scarcity.

Purpose of the Study:

• To review the current status of liver transplantation in China.
• To identify and analyze the key challenges and problems associated with liver transplantation procedures in the country.

Main Methods:

• A comprehensive literature search was conducted using MEDLINE for English-language articles (1990-2003).
• Related reports and review articles in Chinese from major Chinese transplant centers were also included.

Main Results:

• Hepatocellular carcinoma (HCC) is a primary indication for liver transplantation, with varying selection criteria across centers.
• Hepatitis B virus (HBV) reinfection is a significant post-transplant issue for HBV-related patients.
• Donor shortage and long-term postoperative care are increasing concerns, with artificial liver support systems used as a bridge to transplantation.

Conclusions:

• HCC remains a major indication for liver transplantation in China.
• Combined hepatitis B immune globulin and lamivudine effectively prevent HBV reinfection.
• Strategies like living donor, split, and marginal donor liver transplantation address donor shortages, while artificial liver support aids bridge-to-transplant.
• Early steroid withdrawal is feasible, contributing to improved long-term survival rates.