Liver transplantation in Egypt : better late than never

الملخص EN

In Egypt ; although end-stage liver disease is a major health concern, patients have only one hope of cure, that is to travel abroad to undergo cadaveric liver transplantation! Two groups of Egyptian liver transplant candidates were studied.

The first group (n = 12) underwent cadaveric liver transplantation in England.

For the second group (n = 64) liver transplantation was not a feasible option and they were followed up for one year in Egypt as a delayed -intervention control group.

Viral-related cirrhosis alone (43.1 %) or mixed with schistosomal fibrosis (48.3 %) were the main indications of candidacy for liver replacement in both groups.

Post-transplant complications included : venous outflow obstruction that resolved by percutaneous balloon dilatation ; biliary anastomotic stricture requiring endoscopic stenting ; severe Cyclosporin induced neurotoxicity resolved by conversion to Tacrolimus, and late acute rejection which responded to high dose steroids and conversion to Tacrolimus.

One patient was relisted for chronic rejection.

One recipient died from aggressive recurrent hepatitis C virus infection 3.5 years posttransplant.

Schistosomiasis did not seem to have any negative impact on the transplant process.

In the transplanted group, 11 patients (91.7 %) survived after a median follow up of 20 months (range 14 to 54 months).

On the other hand, and among the control group, only 9 patients ((19.5 %) survived for one year.

In the view of this marked difference in survival with versus without liver transplantation , developing a liver transplant program in Egypt became a necessity and strong efforts should be made to overcome all the hurdles whether religious, legal, economical, or cultural.