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Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Liver transplantation in the developing world
1Department of Paediatrics, University Children's Medical Institute, National University Hospital, National University of Singapore, Singapore. paeqsh@nus.edu.sg
Insights
Paediatric liver transplantation in developing nations faces challenges like resource limitations and awareness gaps. However, established programs show comparable survival rates to developed countries, with de-novo hepatitis B being a key concern.
Area of Science:
- Hepatology
- Transplantation Surgery
- Global Health
Background:
- Paediatric liver transplantation is a complex procedure with unique challenges in resource-limited settings.
- Developing countries often grapple with infrastructure, trained personnel, and public/professional awareness deficits regarding liver transplantation benefits.
Purpose of the Study:
- To review the challenges and progress of paediatric liver transplantation in the developing world.
- To identify key issues hindering transplant program establishment and success in these regions.
Main Methods:
- Literature review of paediatric liver transplantation programs in developing countries.
- Analysis of reported challenges, outcomes, and survival rates.
Main Results:
- Significant obstacles include manpower training, resource scarcity, ethical considerations, donor availability, and limited awareness.
- Successfully established programs demonstrate outcomes and long-term survival rates comparable to developed nations.
- Complication rates are similar to those in developed countries, with de-novo hepatitis B identified as a risk factor.
Conclusions:
- Despite numerous challenges, paediatric liver transplantation in developing countries is feasible and yields encouraging long-term survival rates.
- Proactive management of de-novo hepatitis B, including maintaining high anti-hepatitis B levels pre-transplant, is crucial for recipient success.
Purpose Of Review:
The purpose of the present paper is to review the problems of paediatric liver transplantation encountered by the developing world and to review the progress made.
Recent Findings:
Setting up of a transplant programme in the developing world is associated with multiple issues, including manpower training and lack of resources. Ethical issues, donor problems and lack of awareness about the benefit of liver transplantations among the medical profession and public are major problems. In countries where the programmes have been successfully established, the outcome and long-term survival rates are comparable to those of the developed world. The complication rates are similar to those in developed countries. De-novo hepatitis B is a risk factor among the recipients and maintaining a high anti-hepatitis B among the recipients prior to transplantation appears to be the solution.
Summary:
Various problems encountered in the developing countries are reviewed. The long-term actuarial survival rates in those countries are encouraging.
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