{Reference Type}: Journal Article
{Title}: Geographic disparities in access to liver transplant for advanced cirrhosis: Time to ring the alarm!
{Author}: Bajaj JS;Choudhury A;Kumaran V;Wong F;Seto WK;Alvares-Da-Silva MR;Desalgn H;Hayes PC;Idilman R;Topazian M;Torre A;Xie Q;George J;Kamath PS;
{Journal}: Am J Transplant
{Volume}: 24
{Issue}: 5
{Year}: 2024 May 21
{Factor}: 9.369
{DOI}: 10.1016/j.ajt.2024.02.018
{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.