Liver transplantation in Asia: Problems and practice.

Area of Science:

• Hepatology
• Transplant Surgery
• Infectious Diseases

Background:

• Liver transplantation in Asia faces challenges including organ donation reluctance, financial constraints, and high hepatitis B prevalence.
• Hepatitis B significantly reduces available cadaveric organs, necessitating alternative strategies for liver transplantation.
• Living-related liver transplantation, initially for pediatric patients, has become crucial in addressing organ scarcity in Asia.

Purpose of the Study:

• To evaluate the progress and challenges of liver transplantation in Asia.
• To assess the efficacy of living-related liver transplantation in overcoming organ shortages.
• To determine the effectiveness of lamivudine in preventing hepatitis B reinfection post-transplantation.

Main Methods:

• Establishment and expansion of living-related liver transplantation for pediatric and adult patients.
• Peri-operative use of lamivudine to combat hepatitis B viral infection in liver transplant recipients.
• Monitoring of hepatitis B surface antigen (HBsAg) and hepatitis B virus DNA in patients receiving lamivudine.

Main Results:

• Over 785 liver transplantations performed in major Asian centers with an 80% patient survival rate.
• Lamivudine demonstrated high efficacy in preventing graft reinfection; HBsAg disappeared in 11 of 15 patients.
• Lamivudine proved cheaper and more convenient than hepatitis B immunoglobulin for graft protection.

Conclusions:

• Despite obstacles, significant progress in liver transplantation is evident in Asia.
• Living-related liver transplantation is a viable solution for organ shortages.
• Lamivudine is an effective and cost-efficient strategy for managing hepatitis B in liver transplant patients.