Geographic Disparities in Access to Liver Transplant for Advanced Cirrhosis: Time to Ring the Alarm!

Abstract

<p>Decompensated cirrhosis and hepatocellular cancer (HCC) are major risk factors for mortality worldwide. Liver transplantation, both live-donor (LDLT) or deceased-donor (DDLT) are lifesaving but there are several barriers towards equitable access. These barriers are exacerbated in the setting of critical illness or acute-on-chronic liver failure (ACLF). Rates of LT vary widely worldwide but are lowest in lower-income countries due to lack of resources, infrastructure, late disease presentation, and limited donor awareness. A recent experience by the CLEARED consortium defined these barriers towards LT as critical towards determining overall survival in hospitalized cirrhosis patients. A major focus should be on appropriate, affordable, and early cirrhosis and HCC care to prevent the need for LT. LDLT is predominant across Asian countries, while DDLT is more common in Western countries; both approaches have unique challenges that add to the access disparities. There are many challenges towards equitable access but uniform definitions of ACLF, improving transplant expertise, enhancing availability of resources, and encouraging knowledge between centers, and preventing disease progression are critical to reduce LT disparities.</p>