Liver Transplantation in the Philippines: Light at the End of the Tunnel.

Abstract

End-stage liver disease is arguably one of the leading burdensome diseases among developing countries such as the Philippines. Although liver transplantation is considered the treatment of choice for decompensated cirrhosis, the establishment of a robust transplant program locally has been protracted as numerous obstacles continue to plague our transplant landscape. Issues on cost, options of having the transplant done overseas, and low rates of deceased donation are some of the difficulties that hamper our program's progress and development. In this study, we aim to present our experience and discuss hurdles, describing the current status of liver transplantation in the country. Herein we report our initial 68 liver transplants covering 35 years. A retrospective review was performed including all transplants done in 4 active transplant centers from August 1988 to December 2023. Recipients were mostly male patients (69%) with hepatitis B as the most common (32%) primary liver disease. Deceased donor liver transplant was more common (65%) with recipients having a median Model for End-Stage Liver Disease (MELD) score of 22. Among living donor liver transplants, 58% of the grafts were from the left lateral segment. Outcomes can be divided into two eras, with the first era (1988-2010) having a 1-year graft survival of only 25%. The second era (2011-present) was marked with surgical refinements and advancing knowledge, improving 1-year graft survival to 64% and 67% for adult and pediatric transplants, respectively. Indeed, the establishment of a liver transplant program requires a team approach and most fundamentally, full training in liver transplantation and the management of its complications. Optimal patient selection remains essential in achieving excellent survival outcomes. Last, Filipinos with liver cirrhosis now have an opportunity for a significant improvement in their quality of life by undergoing transplantation in their native country.