Status, Advances, and Challenges in Pediatric Liver Transplantation in Africa: A Scoping Review
Brian Kasagga1, Joseph Thaimye2, Daniel Lawal3
1Department of Surgery, Institute for African Research Innovation and Education, Port Harcourt, Nigeria; Department of Surgery, Makerere University School of Medicine, Kampala, Uganda; Department of Surgery, Society of Uganda Gastrointestinal and Endoscopic Surgeons, Kampala, Uganda; Organ Donation Research Division, SOTA Research Group, Uganda.
Insights
Pediatric liver transplantation (PLT) in Africa is limited, with only two countries offering the procedure. Addressing challenges like donor shortages and late referrals is crucial for improving patient outcomes.
Area of Science:
- Hepatology
- Transplantation Surgery
- Global Health
Background:
- Pediatric liver diseases pose a significant mortality risk in low-income countries, especially in Africa.
- Access to pediatric liver transplantation (PLT) is severely restricted across the African continent.
Purpose of the Study:
- To assess the current status of PLT in Africa.
- Identify key barriers hindering access to PLT.
- Propose actionable solutions to improve PLT services.
Main Methods:
- Comprehensive literature search of peer-reviewed articles, reports, and gray literature.
- Inclusion of studies on PLT from January 2000 to July 2024.
- Data extraction and summarization using established frameworks (Arksey, O'Malley, JBI).
Main Results:
- Only South Africa and Egypt have PLT programs, performing approximately 548 transplants.
- Biliary atresia is the primary indication; 66% of patients face waits exceeding one year.
- Africa's survival rates (79.4% 1-y, 67.4% 5-y) lag behind global averages (86.6% 1-y, 77.7% 5-y).
- Key challenges include limited infrastructure, donor scarcity, late referrals, and financial barriers.
Conclusions:
- PLT in Africa faces significant access limitations and inferior outcomes compared to global benchmarks.
- Enhancing resources, early diagnosis, deceased donor programs, policy development, and education are essential for progress.
Introduction:
Pediatric liver diseases are a significant mortality burden in low-income countries particularly in Africa, where access to life-saving pediatric liver transplantation (PLT) is limited. We aimed to determine the current state of PLT in Africa based on the available literature, identify key barriers to access, and propose solutions.
Methods:
We conducted a comprehensive search of peer-reviewed articles, reports, and gray literature from databases such as Google Scholar, PubMed Central, Web of Science, and African Journal Online. We included studies on PLT between January 2000 and July 2024. Data were extracted, collated, and summarized following the Arksey, O'Malley, and Joanna Briggs Institute frameworks.
Results:
Only two African countries have PLT programs, located in South Africa and Egypt. Approximately 548 PLTs were performed, with 388 in South Africa and 160 in Egypt. Biliary atresia is the leading indication (43.1%). Sixty-six percent of patients wait longer than a year for a transplant. Living donors are predominantly used, with deceased donor programs primarily located in South Africa. Compared to global 1-y and 5-y survival rates of 86.6% and 77.7%, survival in Africa is at 79.4% and 67.4%, respectively. PLT complications include biliary (41%), vascular (16%), and enteric (10%). Major challenges include limited access and infrastructure, donor shortages, late referrals, diagnostic delays, financial and socioeconomic barriers, clinical and postoperative complications, and policy bottlenecks.
Conclusions:
PLT in Africa has limited access and poorer outcomes compared to global trends. Addressing these requires increasing resources, improved early diagnosis, expanded deceased donor programs, policy development, education, and resource allocation.
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