TY - JOUR
T1 - Geographic disparities in access to liver transplant for advanced cirrhosis
T2 - Time to ring the alarm!
AU - Bajaj, Jasmohan S.
AU - Choudhury, Ashok
AU - Kumaran, Vinay
AU - Wong, Florence
AU - Seto, Wai Kay
AU - Alvares-Da-Silva, Mario Reis
AU - Desalgn, Hailemichael
AU - Hayes, Peter C.
AU - Idilman, Ramazan
AU - Topazian, Mark
AU - Torre, Aldo
AU - Xie, Qing
AU - George, Jacob
AU - Kamath, Patrick S.
N1 - Publisher Copyright:
© 2024 American Society of Transplantation & American Society of Transplant Surgeons
PY - 2024
Y1 - 2024
N2 - Decompensated cirrhosis and hepatocellular cancer are major risk factors for mortality worldwide. Liver transplantation (LT), both live-donor LT or deceased-donor LT, are lifesaving, but there are several barriers toward equitable access. These barriers are exacerbated in the setting of critical illness or acute-on-chronic liver failure. Rates of LT vary widely worldwide but are lowest in lower-income countries owing to lack of resources, infrastructure, late disease presentation, and limited donor awareness. A recent experience by the Chronic Liver Disease Evolution and Registry for Events and Decompensation consortium defined these barriers toward LT as critical in determining overall survival in hospitalized cirrhosis patients. A major focus should be on appropriate, affordable, and early cirrhosis and hepatocellular cancer care to prevent the need for LT. Live-donor LT is predominant across Asian countries, whereas deceased-donor LT is more common in Western countries; both approaches have unique challenges that add to the access disparities. There are many challenges toward equitable access but uniform definitions of acute-on-chronic liver failure, improving transplant expertise, enhancing availability of resources and encouraging knowledge between centers, and preventing disease progression are critical to reduce LT disparities.
AB - Decompensated cirrhosis and hepatocellular cancer are major risk factors for mortality worldwide. Liver transplantation (LT), both live-donor LT or deceased-donor LT, are lifesaving, but there are several barriers toward equitable access. These barriers are exacerbated in the setting of critical illness or acute-on-chronic liver failure. Rates of LT vary widely worldwide but are lowest in lower-income countries owing to lack of resources, infrastructure, late disease presentation, and limited donor awareness. A recent experience by the Chronic Liver Disease Evolution and Registry for Events and Decompensation consortium defined these barriers toward LT as critical in determining overall survival in hospitalized cirrhosis patients. A major focus should be on appropriate, affordable, and early cirrhosis and hepatocellular cancer care to prevent the need for LT. Live-donor LT is predominant across Asian countries, whereas deceased-donor LT is more common in Western countries; both approaches have unique challenges that add to the access disparities. There are many challenges toward equitable access but uniform definitions of acute-on-chronic liver failure, improving transplant expertise, enhancing availability of resources and encouraging knowledge between centers, and preventing disease progression are critical to reduce LT disparities.
KW - ACLF
KW - CLEARED consortium
KW - World Bank
KW - access
KW - deceased-donor transplant
KW - gender
KW - hepatocellular cancer
KW - live-donor transplant
KW - resources
UR - http://www.scopus.com/inward/record.url?scp=85186618424&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85186618424&partnerID=8YFLogxK
U2 - 10.1016/j.ajt.2024.02.018
DO - 10.1016/j.ajt.2024.02.018
M3 - Article
C2 - 38387623
AN - SCOPUS:85186618424
SN - 1600-6135
JO - American Journal of Transplantation
JF - American Journal of Transplantation
ER -