Liver Diseases in Latin America: Current Status, Unmet Needs, and Opportunities for Improvement

Abstract

Purpose of review To assess the current challenges regarding liver diseases, including the burden of disease, access to care, screening, and treatment needs in Latin America. Recent findings Latin America is a region with a rich multicultural heritage and important socioeconomic differences. The burden of liver diseases is high and mainly determined by a high level of alcohol intake and the surge of risk factors associated with NAFLD (i.e., sedentary lifestyles, broader access to highly processed foods, obesity, and type 2 diabetes mellitus). Hepatotropic viruses also play a role in the development of chronic liver diseases, although their comparative frequency has been decreasing over the last decades. There are important disparities in access to screening and treatment for liver diseases in Latin America, which are reflected in low accessLiver (E Tapper, Section Editor) to critical treatments such as direct-acting antiviral agents and drugs to treat hepatocellular carcinoma. Also, important barriers to liver transplantation are present in multiple countries, including a low deceased donors' rate and a lack of availability in several countries (especially in Central America). Our region also has disadvantages in research and education in liver diseases, which limits regional academic development and improvement in quality of care of liver diseases. Summary In order to tackle an increasing health burden due to liver diseases, Latin America urgently needs tailored interventions aiming to control the main risk factors for these disorders through the establishment of effective public health policies. Also, development of liver transplantation programs and improvement of medical education and research capabilities as well as extensive collaboration between all stakeholders are keys to address the liver disease agenda in the region. AbbreviationsACLF Acute-on-chronic liver failure ALD Alcohol-associated liver disease ALF Acute liver failure AUD Alcohol use disorder DALYs Disability-adjusted life-years DILI Drug-induced liver injury GDP Gross domestic product HBV Hepatitis B virus HCV Hepatitis C virus HDV Hepatitis delta virus HCC Hepatocellular carcinoma LT Liver transplantation MAFLD Metabolic dysfunction-associated fatty liver disease NAFLD Non-alcoholic fatty liver disease NASH Non-alcoholic steatohepatitis PHP Public health policies PNPLA3 Patatin-like phospholipase domain-containing 3 US United States USD United States Dollars WHO World Health Organization * Updated to 2019 + Updated to 2020 Country Population in 2019 GDP + Gini index* Life expectancy from birth (years)* Deceased donors' rate* DDLT rate* LDLT rate* Argentina 44,938,712

Global epidemiology of cirrhosis — aetiology, trends and predictions

“…Taken together, these data suggest that the aetiology of cirrhosis in the Americas is shifting from active HBV and HCV infection towards resolved or treated viral hepatitis, alcohol consumption and NAFLD. These data are in line with increases in obesity and alcohol consumption in the Americas 40 – 42 .…”

The silent burden of non‐alcoholic fatty liver disease in the elderly: A global burden of disease analysis

“…Specifically, regions within the Americas grappling with constrained healthcare resources or unequal healthcare provisions might encounter difficulties in the timely and efficient management of NAFLD 34,35 . Notably, there appears to be a heightened NAFLD burden among those in lower socioeconomic brackets, potentially exacerbated by the widening economic disparity between the affluent and the economically disadvantaged 36–38 . In addition, the genetic predisposition, such as the mutation in the patatin‐like phospholipase domain‐containing protein 3 (PNPLA3), which is more prevalent in Hispanics and linked to a higher risk of steatohepatitis could play a role in this observed rise in the burden in this region 39 .…”

“…34,35 Notably, there appears to be a heightened NAFLD burden among those in lower socioeconomic brackets, potentially exacerbated by the widening economic disparity between the affluent and the economically disadvantaged. [36][37][38] In addition, the genetic predisposition, such as the mutation in the patatin-like phospholipase domain-containing protein 3 (PNPLA3), which is more prevalent in Hispanics and linked to a higher risk of steatohepatitis could play a role in this observed rise in the burden in this region. 39 However, the specific mechanism underlying this rising mortality and morbidity warranted confirmation by further study.…”

Steatotic Donor Transplant Livers: Preservation Strategies to Mitigate against Ischaemia-Reperfusion Injury

“…Similarly, in the United States, it is estimated that by 2030, 48.9% of the adult population will be obese with a BMI ≥ 30 kg/m 2 and 24.2% will be severely obese with a BMI ≥ 35 kg/m 2 [4]. With the ongoing global obesity crises, it is inevitable that MASLD (resulting in metabolic-associated steatohepatitis, MASH) will become one of the primary indications for liver transplantation (LT) and at the same time, HS will also become more prevalent in the donor pool [5,6].…”