Liver transplantation in China: problems and their solutions.
BACKGROUND
The past decade has witnessed the rapid development of liver transplantation in China. The 1-year survival of liver transplant patients comes to 80% in many leading medical centers and the number of liver transplantation is increasing. However, liver transplantation in China is facing several challenges including recipient with hepatocellular carcinoma (HCC), recurrence of HCC and hepatitis B, long-term postoperative care, the bridge to liver transplantation, and shortage of liver donor. This review was to understand the status of and problems in liver transplantation in China.


METHODS
An English-language literature search using MEDLINE (1990-2003) on liver transplantation and other related reports and review articles in Chinese from major transplant centers in China.


RESULTS
HCC is one of the main indications for liver transplantation in China but different centers adopted different criteria for selection of patients. Hepatitis B virus reinfection is a vital problem after liver transplantation in HBV-related patients. More and more attention was focused on long-term postoperative care and donor shortage. Artificial liver support system has been applied in patients waiting for a graft in many centers.


CONCLUSIONS
HCC remains to be one of the main indications for liver transplantation in China; combined hepatitis B immune globulin and lamivudine is considered effective to prevent hepatitis B virus reinfection. Apart from long-term postoperative care for the improvement of the survival rate, early steroid withdrawal is feasible in liver transplantation. Living donor liver transplantation, split liver transplantation, and marginal donor transplantation can deal with donor shortage to some extent. Artificial liver assist system serves as a bridge to liver transplantation.
Wu
Jian
J
Department of Hepatobiliary Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Zheng
Shu-Sen
SS
D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D002681:China; D006509:Hepatitis B / Q000209:etiology; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors / Q000600:supply & distribution; D009364:Neoplasm Recurrence, Local; D005791:Patient Care / Q000379:methods