Liver transplantation in China: problems and their solutions

BACKGROUND: The past decade has witnessed the rapid development of liver transplantation in China. The 1-year survival of liver transplant patients comes to 80% in many leading medical centers and the number of liver transplanta- tion is increasing. However, liver transplantation in China is facing several challenges including recipient with hepato- cellular carcinoma (HCC), recurrence of HCC and hepati- tis B, long-term postoperative care, the bridge to liver transplantation, and shortage of liver donor. This review was to understand the status of and problems in liver trans- plantation in China. DATA RESOURCES: An English-language literature search using MEDLINE (1990-2003) on liver transplantation and other related reports and review articles in Chinese from major transplant centers in China. RESULTS: HCC is one of the main indications for liver transplantation in China but different centers adopted dif- ferent criteria for selection of patients. Hepatitis B virus re- infection is a vital problem after liver transplantation in HBV-related patients. More and more attention was fo- cused on long-term postoperative care and donor shortage. Artificial liver support system has been applied in patients waiting for a graft in many centers. CONCLUSIONS: HCC remains to be one of the main indi- cations for liver transplantation in China; combined hepati- tis B immune globulin and lamivudine is considered effec- tive to prevent hepatitis B virus reinfection. Apart from long-term postoperative care for the improvement of the survival rate, early steroid withdrawal is feasible in liver transplantation. Living donor liver transplantation, split liv- er transplantation, and marginal donor transplantation can deal with donor shortage to some extent. Artificial liver as- sist system serves as a bridge to liver transplantation.