Status of Liver Transplantation in the Arab World

The liver transplantation experience of 11 countries in the League of Arab States is presented in this Regional Perspective and provided in an ongoing series of such perspectives through the auspices of The Transplantation Society (1Y3). The history and current experience of 27 liver transplant centers throughout these 11 countries is a seminal recording of both deceased (DDLT) and living donor (LDLT) liver transplantation in the Arab World. The data of this report were assembled by responses to an email questionnaire from 26 of the 27 centers with information regarding the date of the first liver transplant (LT), the total number of LT (including DDLT and LDLT), and the most common indication for LT in those centers. The Arab World is composed of 22 countries in the League of Arab States founded in 1945. It has a combined population of approximately 350 million people and is united by Arabic language, culture, Islamic religion, and geographic contiguity. Additionally, certain Arab countries share a high prevalence of viral hepatitis with an increasing need for LT in those countries (4, 5). The first DDLT in the Arab World was performed in 1990 at Riyadh Military Hospital in Saudi Arabia (6). The first LDLTwas performed in 1991 at the National Liver Institute in Egypt (7). Between 1990 and August 2013, 3,804 liver transplants (3,052 [80%] LDLT and 752 [20%] DDLT) were performed at the 27 in 11 Arab countries (Table 1). The largest percentage of liver transplantation has been performed by 13 transplant centers in Egypt (56%) followed by four transplant centers in Saudi Arabia (35%) and two transplant centers in Jordan (5%). In the remaining eight Arab countries, liver transplant activity has been limited to one program in each country. The most common indication for LT in this series was end-stage liver cirrhosis caused by hepatitis C virus or hepatitis B virus, with or without hepatocellular carcinoma. More than 70% of the LDLT in this series were performed by the transplant centers in Egypt (Table 2) with five living donor deaths reported (0.2% rate of mortality) (8Y12). Egypt has the highest prevalence of hepatitis C virus (HCV) worldwide, estimated to be 15% and 26% of the population (13). More than 90% of the DDLT in this series were performed in Saudi Arabia; four liver transplant centers in Saudi Arabia have collectively performed 1,338 LT (52% DDLT and 48% LDLT), including 13 split LT procedures. There were no reported living donor deaths in Saudi Arabia (14, 15). A small number of transplants have been performed in Algeria, Tunisia, and Lebanon (16, 17). The initial transplant programs in Libya, Kuwait, and United Arab Emirates performed a few liver transplants, but they were subsequently suspended because of logistical and technical reasons. A program for LDLT has recently been developed in Iraq with a potential of performing 15 LDLT per year; also, a DDLT program has begun in Qatar with four transplants performed to date (18). Missing in this report are the current annual data of patient and allograft survival. The progress of liver transplantation Transplantation Society Regional Perspectives