Ten years of experience of liver transplantation in Singapore

MARS®: a futile tool in centres without active liver transplant support

“…Patients who were rejected for liver transplant due to medical (e.g., concomitant significant ischaemic hear disease) or social reasons (e.g., active alcoholics), patients with advanced liver cancer, or patients thought to have imminent death were not treated with MARS s . At our centre, the decision to list patients for liver transplant or to initiate MARS s treatment was based mainly on medical grounds, when patients had ALF, decompensated liver cirrhosis, or when they had unresectable hepatocellular carcinoma within the Milan criteria (16). Cost was not a major issue in medical decision, as medical care has been heavily subsidised by the government, and various schemes and funds were available for needy patients to pay for the balance payment (17).…”

“…MARS ® has been available at our centre since February 2000 as a pilot project and an auxiliary treatment tool for patients with ALF or AoCLF. However, due to the low availability of DDLT or LDLT at our centre (at average of 5–10 cases/year), many of our patients did not undergo liver transplantation (13). Hence, results of MARS ® in our centre were not confounded by patients undergoing emergency liver transplant.…”

Primary biliary cirrhosis in Singapore: Evaluation of demography, prognostic factors and natural course in a multi‐ethnic population

“…In planning this retrospective study, we made a conscious effort to identify and define our end‐points clearly. Singapore has an active liver transplant program with an ‘opt‐out’ cadaveric donor scheme, 10,11 and so patients with advanced PBC as per the Mayo risk or model of end‐staged liver disease (MELD) score 12 were offered and placed on the transplant waiting list. Three of our patients had successful transplants and survived.…”

Current Issues and Treatment of Fulminant Hepatic Failure including Transplantation in Hong Kong and the Far East

“…To overcome the shortage of organ donors, living-donor liver transplantation (LDLT) is being performed increasingly in such places as Japan, Hong Kong, Taiwan, Singapore, and South Korea. [128][129][130][131][132] In the first series reported by the Japanese, 19 (56%) of the 34 patients with fulminant hepatic failure survived after LDLT. 128 In LDLT, the limit of the graft volume is an important issue because a small-sized graft is prone to reperfusion injury leading to primary graft nonfunction.…”

“…127 Apart from Japan and Hong Kong, liver transplantation for fulminant hepatic failure has also been performed in Singapore and South Korea, with a posttransplant mortality ranging from 10 to 75%. 131,132 In the Far East, most of the fulminant hepatic failure is related to HBV infection. In these subjects, HBV recurrence was frequent and could result in lower graft and patient survival rates.…”