Liver Transplantation: East versus West.

Area of Science:

• Hepatology and Transplant Surgery
• Global Health Disparities in Organ Transplantation

Background:

• Liver transplantation (LT) has evolved since 1967, becoming a standard treatment for end-stage liver disease (ESLD) by the 1980s.
• Approximately 25,000 LTs are performed globally annually with a 90% one-year survival rate.
• Living donor liver transplantation (LDLT) emerged in East Asia in the 1990s to address graft shortages, contrasting with the deceased donor liver transplantation (DDLT) dominance in Western countries.

Purpose of the Study:

• To provide an overview of the evolution and current status of liver transplantation worldwide.
• To highlight regional variations in LT practices, etiologies of liver failure, and organ allocation systems.
• To compare outcomes between LDLT and DDLT and discuss the ongoing debate on prognostic models.

Main Methods:

• Review of historical data and current global practices in liver transplantation.
• Comparative analysis of etiologies for acute liver failure (ALF) and ESLD across different regions.
• Examination of organ allocation models, including the Model for End-Stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) score.

Main Results:

• LDLT is the predominant method in India and other Asian countries, while DDLT accounts for over 90% of LTs in the West.
• Etiologies for LT differ globally: drug-induced ALF in the West versus viral hepatitis in Asia; alcoholic cirrhosis and Hepatitis C Virus (HCV) in the West versus Hepatitis B Virus (HBV) in the East.
• Outcomes of LDLT in Eastern countries are comparable to Western programs, despite initial disparities.

Conclusions:

• Liver transplantation techniques and indications show significant geographical variation.
• The choice between LDLT and DDLT is influenced by regional donor availability and cultural factors.
• Standardization of organ allocation models remains a challenge, with ongoing debate regarding the optimal prognostic system.