Liver transplantation in the Moscow Region: the regional project and its implementation

Abstract

Rationale: Liver transplantation is the only curative treatment for diffuse end-stage liver disease and some liver neoplasms. The amount of these interventions in the Moscow Region is very low.Aim: To analyze the results of the first series of liver transplantations done in the Moscow Regional Research and Clinical Institute (MONIKI), to compare it with those done currently in Russia and worldwide, and to establish the optimal volume and trend of development for this new regional center.Materials and methods: More than 200 patients with liver cirrhosis, polycystosis and alveococcus invasion have been examined from May 2016 to August 2018; 70 of them were eligible for liver transplantation and were put on the waiting list. From October 2016 to July 2018, 29 liver transplantations from deceased donors (including 2 retransplantations) and one living related transplantation of the right lobe have been performed. Among the indications to the transplantation, the leading one was viral (HCV or HBV-related) cirrhosis. Four patients were diagnosed with hepatocellular carcinoma.Results: The waitlist mortality was 19%. Median waiting time was 5.5 [3; 9] (0 to 27) months. Until now, the results were followed till 22 months, with median follow-up of 7 [2; 13] months. The survival rate of the recipients was 96.4%, of the grafts 93.3%. In-patient mortality was 3.6%. Early allograft dysfunction was seen in 33% of cases. Median length of the in-hospital stay was 22 [19; 25] days.Conclusion: The successful implementation of the liver transplant program at its initial stage demonstrates the results that meet current efficacy criteria. Achieved level of organ procurement from deceased donors in the Moscow Region could ensure at least 30 liver transplantations annually, with current facilities and a potential for further growth. An increase in the transplantation number would depend on the improvement of transplantation service facilities in MONIKI and on the stable financial support of the program. Finally, it would promote increased availability of this transplantation technology in the region, lower waitlist mortality and shorter waiting times.

Liver Transplantation in Hepatitis B/Hepatitis D (Delta) Virus Coinfected Recipients

“…Fewer HDV patients have been transplanted outside Europe 12,13,35,36 ; they were usually included within larger series of HBsAg cirrhotics, and their virological course and clinical data are often incomplete. Rates of HDV and HBsAg recurrence were nevertheless low and survival rates high also in these series.…”

“…The burden of the infection is far larger in many low-income countries of Africa and Asia, which have no access to LT programs. 6 In several countries that run HDV transplant programs, such as Iran (H Sharafi personal communication), Pakistan (S Hamid personal communication), Romania, 12 and Russia, 13 HDV patients were included within series of HBsAg-positive transplants without further separate consideration. In many high-income countries, alert to hepatitis D remains low and testing for HDV has been generally unemployed, on the perception that HDV is no longer a medical problem.…”