Patients Seeking Liver Transplant Turn to China: Outcomes of 15 Egyptian Patients Who Went to China for a Deceased-Donor Liver Transplant

Abstract

Objectives: Increasing numbers of Egyptians with end-stage liver disease seek liver transplants in China because of lower costs and shorter wait times. We evaluated outcomes of Egyptian patients who underwent liver transplants in China and address ethical concerns.

Material and Methods: Fifteen Egyptian patients (11 men, 4 women; mean age, 52 years) who underwent liver transplants in China were included. Preoperative data before traveling to China, reports from China, and follow-up data upon return were reviewed.

Results: Indications included hepatitis-C–related liver cirrhosis (n=9), hepatitis-C–related liver cirrhosis with hepatocellular carcinoma (n=4), and hepatitis-B–related liver cirrhosis (n=2). Nine patients were evaluated for living-related liver transplant but none of their potential donors was suitable. Three patients had advanced hepato­cellular carcinoma and were not accepted for living-related liver transplant by any Egyptian center. Two patients had no living-related donor. One patient refused a living-related liver transplant in Egypt and elected to get a whole liver graft from China. Overall survival rate was 80.0% at 6 months and 73.3% at 12 months. There were 4 deaths; 2 occurred in China. Of the 11 surviving patients, 9 (82%) developed complications. Nineteen complications were seen in the 13 patients who were managed after returning from China. Major complications necessitating prolonged hospitalizations occurred in 4 patients. Two patients required further laparotomy.

Conclusions: Although deceased-donor liver transplant in China could be an option for Egyptian patients with end-stage liver disease, patients and clinicians should be aware of potential outcomes and related ethical issues.