Liver transplantation in Egypt from West to East

Abstract

Background: Egyptian patients with end-stage liver disease need to seek whole cadaveric liver transplantation (CLT) abroad. We studied the outcome of Egyptian patients who underwent CLT in China. Methods: Between 2004Between -2006 patients who underwent CLT in China and attended two liver surgery outpatient clinics in Egypt for follow-up were included in the study. Demographic, preoperative, postoperative, and follow-up data after coming back from China were reviewed. Results: For 22 patients of median age 48 years (30-62) and with BMI 27.5 ± 6.2, the median follow-up was 23.5 months (range 1-48); 18 patients were males. Hepatitis C (HCV)-cirrhosis alone or with schistosomiasis was the main indication for CLT (n = 12); Hepatitis B (HBV)-cirrhosis was the indication for transplantation in two patients, HCV-cirrhosis with hepatocellular carcinoma (HCC) in six, HBV-cirrhosis with HCC in one, and both HBV-and HCV-related cirrhosis with HCC in another. There were eight deaths, one as a result of primary nonfunction, one because of postoperative bleeding, two because of recurrent HCV, and four because of recurrent HCC. Overall survival at one and three years was 68.5% and 64%, respectively, and 50% and 37.5% for HCC patients, respectively, while three-year survival was 80% for hepatitis patients. Twelve patients (54%) developed complications. Biliary complications occurred in 45% of cases. Conclusion: CLT tourism to China raises serious concerns regarding selection criteria and ethical issues. Furthermore, the negative impact of this practice on the successful setting up of LT programs in Egypt must be addressed carefully. In Egypt efforts should be directed to get legalization for CLT.

Current situation of viral hepatitis in Egypt

“…Yosry et al 241 reported that HCV‐related end‐stage liver diseases are the main indication for living donor liver transplantation, representing 89.8% of all cases in Egypt, while HBV indication represented 5.1% of all cases. Between 2004 and 2006, 22 Egyptian patients underwent cadaveric liver transplantation in China, and HBV was the indication for transplantation in three patients (two with cirrhosis and one with HCC), while HCV with cirrhosis or HCC was the main indication in the remaining patients 242 . The cost of living donor liver transplantation in a private hospital in Egypt is approximately $70,000, while it is $25,000 in governmental hospital 243 .…”

Pattern of Recurrent Hepatitis C in Deceased vs Living Donor Liver Transplantation: An Egyptian Experience

“…The Egyptian National Committee on Viral Hepatitis stated that 9.8% of the Egyptians are HCV infected, whereas other UHVHDUFKHUV FODLP WKDW WKH ¿JXUH LV EHWZHHQ DQG 17 As DDLT being still not a valid option in Egypt, LDLT seemed to be the only choice to save many patients in desperate need for LT. 18 The current study was conducted to compare the pattern of recurrent hepatitis C, including the possible risk factors, ˪ RQVHW VHYHULW\ DQG WKH HI¿FDF\ RI +&9 WUHDWPHQW LQ ''/7 versus LDLT candidates.…”

Invasive aspergillosis in liver transplant recipients

“…10 The high cost, shortage of organs, and long waiting lists have opened the way to transplant tourism, sometimes illegal, with significant economic implications (∼$40 000-300 000 per patient). 11,12 The number of LTs has increased exponentially since the 1980s and has almost doubled in recent decades in the United States and Europe. 2,3 Nevertheless, the COVID-19 pandemic impacted liver transplantation activity, which decreased by 11% between 2019 and 2020, with dramatic consequences for candidates waiting for a liver.…”

“…The demand for LTs continues to rise, but organ donation remains insufficient and has not kept pace with demand. 10 The high cost, shortage of organs, and long waiting lists have opened the way to transplant tourism, sometimes illegal, with significant economic implications (∼$40 000–300 000 per patient) 11 , 12 …”