Liver transplantation in Asia: Problems and practice

Liver transplantation in Asia has been difficult to establish due to: a reluctance in Asians to donate organs; a lack of financial support; and the predominance of hepatitis B in the population, which effectively reduces the number of cadaveric organs. To overcome the problem of organ shortage, living‐related liver transplantation for paediatric patients was rapidly established initially at Kyoto University, Japan, and then in several centres in Asia. Living‐related liver transplantation was extended to adults using the left lobe in 1994 and using the right lobe in 1996. Up to May 1998, 785 liver transplantations had been performed in major centres in Asia with a patient survival rate approaching 80%. To overcome the problem of hepatitis B viral infection, lamivudine is now used peri‐operatively. Lamivudine is shown to be very effective in preventing graft reinfection. Of the 15 patients who received lamivudine and liver transplantation at Queen Mary Hospital, hepatitis B surface antigen (HBsAg) disappeared in 11 patients and hepatitis B virus DNA was not detectable in any of them. Two patients had a reappearance of HBsAg after an initial loss, but their liver grafts were not affected by hepatitis. Compared with hepatitis B immunoglobulin, lamivudine is definitely cheaper and more convenient. In conclusion, even though there are major obstacles to liver transplantation in Asia, steady progress is being made. Hopefully, when the number of cadaveric grafts increases in future, an increasing number of patients can benefit.