Abstract：
Decompensated cirrhosis and hepatocellular cancer are major risk factors for mortality worldwide. Liver transplantation (LT), both live-donor LT or deceased-donor LT, are lifesaving, but there are several barriers toward equitable access. These barriers are exacerbated in the setting of critical illness or acute-on-chronic liver failure. Rates of LT vary widely worldwide but are lowest in lower-income countries owing to lack of resources, infrastructure, late disease presentation, and limited donor awareness. A recent experience by the Chronic Liver Disease Evolution and Registry for Events and Decompensation consortium defined these barriers toward LT as critical in determining overall survival in hospitalized cirrhosis patients. A major focus should be on appropriate, affordable, and early cirrhosis and hepatocellular cancer care to prevent the need for LT. Live-donor LT is predominant across Asian countries, whereas deceased-donor LT is more common in Western countries; both approaches have unique challenges that add to the access disparities. There are many challenges toward equitable access but uniform definitions of acute-on-chronic liver failure, improving transplant expertise, enhancing availability of resources and encouraging knowledge between centers, and preventing disease progression are critical to reduce LT disparities.
摘要：
失代偿期肝硬化和肝细胞癌（HCC）是全球死亡的主要危险因素。肝移植,活体捐献者（LDLT）或死者捐献者（DDLT）都可以挽救生命，但在公平获取方面存在一些障碍。这些障碍在危重病或慢性急性肝衰竭（ACLF）的情况下加剧。LT率在世界范围内差异很大，但由于缺乏资源，低收入国家最低。基础设施,晚期疾病表现，和有限的捐助者意识。CLEARED联盟最近的经验将这些对LT的障碍定义为对确定住院肝硬化患者的总体生存率至关重要。一个主要的重点应该是适当的，负担得起的,以及早期肝硬化和HCC护理，以防止需要LT。LDLT在亚洲国家占主导地位，虽然DDLT在西方国家更常见；这两种方法都有独特的挑战，增加了访问差距。公平获取面临许多挑战，但ACLF的统一定义，提高移植专业知识，提高资源的可用性，鼓励中心之间的知识，预防疾病进展对减少LT差异至关重要。
