Living donor liver transplantation in Egypt

Abstract

In Egypt there is no doubt that chronic liver diseases are a major health concern. Hepatitis C virus (HCV) prevalence among the 15-59 years age group is estimated to be 14.7%. The high prevalence of chronic liver diseases has led to increasing numbers of Egyptian patients suffering from end stage liver disease (ESLD), necessitating liver transplantation (LT). We reviewed the evolution of LT in Egypt and the current status. A single center was chosen as an example to review the survival and mortality rates. To date, deceased donor liver transplantation (DDLT) has not been implemented in any program though Egyptian Parliament approved the law in 2010. Living donor liver transplantation (LDLT) seemed to be the only logical choice to save many patients who are in desperate need for LT. By that time, there was increase in number of centers doing LDLT (13 centers) and increase in number of LDLT cases [2,400] with improvement of the results. Donor mortality rate is 1.66 per 1,000 donors; this comprised four donors in the Egyptian series. The exact recipient survival is not accurately known however, and the one-year, three-year and five-year survival were 73.17%, 70.83% and 64.16% respectively in the International Medical Center (IMC) in a series of 145 adult to adult living donor liver transplantation (AALDLT) cases. There was no donor mortality in this series. LDLT are now routinely and successfully performed in Egypt with reasonable donor and recipient outcomes. Organ shortage remains the biggest hurdle facing the increasing need for LT. Although LDLT had reasonable outcomes, it carries considerable risks to healthy donors. For example, it lacks cadaveric back up, and is not feasible for all patients. The initial success in LDLT should drive efforts to increase the people awareness about deceased organ donation in Egypt.

Keywords: Egypt; Liver; living donor liver transplantation (LDLT); transplantation.

Figure 1

The exact number of LDLT done in Egypt annually. LDLT, living donor liver transplantation.

Figure 2

The number of adult and pediatric patients underwent LDLT. LDLT, living donor liver transplantation.

Figure 3

Indications of LDLT. LDLT, living donor liver transplantation.

Figure 4

Potential donors for LDLT. LDLT, living donor liver transplantation.

Figure 5

(A) 3D portal analysis of a donor with trifurcated PV; (B) the Y natural venous graft taken from the explanted liver.

Figure 6

(A) 3D venous analysis of a donor with a big V5; (B) the use of the umbilical vein as a natural vascular graft.

Figure 7

(A) 3D venous analysis of a donor with a big V5; (B) a ringed expanded polytetrafluorethylene (ePTFE) synthetic vascular graft.

Figure 8

Innovated graft selection algorithm. LDLT, living donor liver transplantation; LLG, left lobe graft; GRWR, graft volume/recipient body weight ratio; RLG, right lobe graft; RPSG, right posterior segment graft; RLV, remnant liver volume.

Figure 9

Survival after LDLT in International Medical Center (IMC). LDLT, living donor liver transplantation.