Liver transplantation in Egypt from West to East

Abstract

Correspondence: Galal El-Gazzaz Department of Colorectal Surgery A30, Cleveland Clinic Foundation, Cleveland, Ohio-44195, USA Tel +1 216 444 3103 Email elgazzg@ccf.org 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 2004–2006, 22 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 HBVand 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.