Transplantation as a treatment option for hepatic echinococcosis past, present, and future - a pooled data analysis of 476 patients.

Liver transplantation (LT) serves as a critical therapeutic intervention for end-stage hepatic echinococcosis. Over time, the emergence of deceased donor LT (DDLT), living donor LT (LDLT), and ex vivo liver resection and autotransplantation (ELRA) has significantly influenced the clinical outcomes of end-stage echinococcosis. All English-language literature on echinococcosis-related LT published in the Web of Science, MEDLINE, and Embase databases from 1980 to 2023 was collected using relevant search terms. Patients' characteristics, surgical features, postoperative complications, mortality, and recurrence rates were systematically analyzed and presented graphically. A total of 44 studies encompassing 476 global echinococcosis patients were analyzed. LT was applied to both male and female patients ranging in age from 10 to 71 years. DDLT and LDLT were primarily indicated for patients with severe hepatic involvement and poor liver function, whereas ELRA was mainly performed in cases with localized lesions, preserved liver function, and a future healthy remnant liver-to-standard liver volume (RLV/SLV) ratio >35%. The major postoperative complication rates were 35.9% (47/131) for DDLT and 30.6% (23/75) for LDLT, both higher than the 23.4% (60/256) rate for ELRA. Overall mortality was highest in DDLT at 27.5% (36/131), compared to 12.0% (9/75) for LDLT and 10.5% (27/256) for ELRA. Recurrence rates were notably higher in DDLT 13.0% (17/131) and LDLT 5.3% (4/75) than in ELRA 0.3% (1/256). LT is a radical treatment option for end-stage alveolar echinococcosis (AE). The need for allotransplantation appears to be decreasing due to early detection and oral benzimidazole administration. Although alternative treatments may be considered, ELRA remains the preferred therapeutic option for end-stage AE patients with adequate remnant liver volume, demonstrating acceptable morbidity and mortality rates. In the future, the widespread adoption of early screening and oral pharmacotherapy is expected to reduce the demand for LT in patients with end-stage disease.