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Geographic disparities in access to liver transplant for advanced cirrhosis: Time to ring the alarm!
Jasmohan S Bajaj1, Ashok Choudhury2, Vinay Kumaran3
1Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, Virginia, USA.
Summary
Liver transplantation (LT) access is limited globally, especially in low-income nations, due to critical illness and resource scarcity. Addressing cirrhosis and liver cancer early is crucial for survival and reducing transplant disparities.
Area of Science:
- Hepatology
- Transplantation Medicine
- Public Health
Background:
- Decompensated cirrhosis and hepatocellular cancer are leading causes of global mortality.
- Liver transplantation (LT) offers life-saving treatment but faces significant access barriers.
- Disparities in LT access are pronounced in critical illness and acute-on-chronic liver failure.
Purpose of the Study:
- To identify and analyze barriers to equitable access in liver transplantation.
- To highlight the impact of these barriers on patient survival, particularly in hospitalized cirrhosis patients.
- To propose strategies for reducing disparities in liver transplantation.
Main Methods:
- Review of global LT rates and contributing factors, with a focus on resource limitations and disease presentation.
- Analysis of data from the Chronic Liver Disease Evolution and Registry for Events and Decompensation (CLIVER) consortium.
- Comparative assessment of live-donor LT (predominant in Asia) and deceased-donor LT (predominant in Western countries) challenges.
Main Results:
- LT rates vary globally, with the lowest rates in lower-income countries due to resource scarcity, infrastructure deficits, late diagnosis, and low donor awareness.
- Barriers to LT significantly impact overall survival in hospitalized cirrhosis patients.
- Differences in live-donor vs. deceased-donor LT approaches contribute to access disparities.
Conclusions:
- Equitable access to liver transplantation is hindered by numerous factors, including resource limitations and disease severity.
- Preventive care for cirrhosis and hepatocellular cancer is essential to reduce the need for LT.
- Key strategies to reduce LT disparities include uniform definitions for acute-on-chronic liver failure, enhanced transplant expertise, resource availability, inter-center knowledge sharing, and disease progression prevention.
