Liver transplantation in Lebanon: A hard lesson to learn.

BACKGROUND: The aim of this study is to review all liver transplants performed at the American University of Beirut Medical Center from 1998 to present.

MATERIAL/METHODS: From 1998 to present, 15 liver transplants were performed in our institution. Of these, 10 were adults and 5 children. Indications for adult transplants were: 2 alcoholic liver cirrhosis, 2 cryptogenic, hepatitis B, hepatitis C with HCC, 1 subacute liver failure, 1 Budd Chiari syndrome, 1 biliary cirrhosis secondary to iatrogenic common bile duct injury, and 1 multiple hydatid disease of the liver. Pediatric transplant indications were: 2 cryptogenic liver cirrhosis, 1 extrahepatic biliary atresia, 1 familial hypercholesterolemia, and 1 congenital hepatic fibrosis. Of the 14 transplants, 4 were living related liver transplants.

RESULTS: Patient survival was 67% at 1, 5 and 10 years. There were 5 deaths at a median of 9 days (range 1-56) post-transplantation. The causes of death were: 2 primary non-functions, 1 intraoperative cardiac arrest, 1 portal and hepatic artery thrombosis, and 1 severe cellular rejection. There were 2 biliary complications and 2 major vascular complications. All 9 survivors are well, with normal liver function tests at a median follow-up time of 70 months (range 13-131) after transplantation.

CONCLUSIONS: Although our numbers are small, the 10-year survival rate is acceptable compared to other series. Cadaveric organ donations and transplantations should be encouraged so that more transplants can be performed. Living related liver transplant is an important alternative source of organs, but should not replace cadaveric donation.