Letter
Liver Transplantation in Latin America Anselmo Abdo
I
would like to bring to our attention the data on liver transplantation in Cuba to supplement the recent article on liver transplantation in Latin America.1 The 11.2 million inhabitants of Cuba have full access to universal public health care coverage, including organ transplantation and immunosuppressive drugs. Legislation supports organ donation after the diagnosis of brain death,2 and since 1982, Cuban citizens have had the opportunity on their identity cards to affirm or deny their wishes for organ donation after death. The National Transplant Office, which is directly linked to the Ministry of Health, was formed in 2002 to emulate the organizational structure of the Spanish model.3 The deceaseddonor organ donation rate was 9.9 per million population (pmp) in 2012 (Table 1). Refusal to donate was seen in only 8.6 % in 2012, which is one of the lowest rates in Latin America.4 The average age of organ donors was 44.6 years, with cerebrovascular disease as the main cause of brain death. The first liver transplantation in Cuba was performed in 1986, but it was not until July 3, 1999, that the liver transplantation program commenced fully.5 The procedures are performed in 3 hospitals (one of them a pediatric hospital, since 2004). We have transplanted 361 livers (3 simultaneous liver-kidney) since 1986 in these 3 centers and have also undertaken living related donor liver transplantation since 2011. On average, the rate of liver transplantation is 1.8 pmp (Table 1), and there were 26 people awaiting a liver at the end of 2012. Hepatitis C and alcoholic cirrhosis are the main adult diagnoses, whereas biliary atresia is the main cause of pediatric liver transplantation. The organ allocation systems give priority to pediatric patients, those with acute liver failure, or
those who need retransplantation. The Model for End-Stage Liver Disease system establishes priority on the waiting list. The 1-year survival for adult patients who underwent transplantation for chronic liver diseases was 73.7% but only 40% for those with acute liver failure.5 There have been 3 successful pregnancies, and the longest survivor to date has been transplanted for 13 years. Additional information is available at www.sld.cu/sitios/trasplante. The Transplantation Section of the Cuban Surgery Society welcomes membership by any health professional involved in transplantation and endorses the Declaration of Istanbul. Starting and maintaining a liver transplantation program is extremely challenging in countries with emerging economies. I agree with the need expressed in this article1 for a Latin American registry to act as a focus for research and regional cooperation. REFERENCES 1. Salvalaggio PR, Caicedo JC, de Albuquerque LC, et al. Liver transplantation in Latin America: the state-of-the-art and future trends. Transplantation 2014;98:241. 2. Legislación sobre donación y trasplante de órganos, tejidos y células: compilación y análisis comparado. Washington, DC: OPS, 2013. http:// www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid= 21392&Itemid=. Accessed August 13, 2014. 3. Abdo A, Ugarte JC, Castellanos R, et al. The transplantation donation process in the Centro de Investigaciones Medico Quirurgicas of Cuba: 1999–2002. Transplant Proc 2003;35:1636. 4. International Figures on Donation and Transplantation—2012. Vol 18. No 1. September 2013. Newsletter Transplant. www.ont.es/publicaciones/ Documents/newsletter_transplant_vol_18_no_1_september_2013.pdf. Accessed August 13, 2014. 5. González L, Abdo AA, López O, et al. First 100 liver transplants at the medico-surgical research center (CIMEQ). Transplant Proc 2006;38: 2473.
TABLE 1.
Number of actual deceased donors per year and liver transplantations performed in Cuba, 1999–2013 Year
Actual deceased donors, n Actual deceased donors, pmp Liver transplantation, n Liver transplantation, pmp Living-donor liver transplantation, % Living-donor liver transplantation, n
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
46 4.1 6 0.5
61 5.4 9 0.8
84 7.5 14 1.2
222 19.8 24 2.1
194 17.3 29 2.6
159 14.2 26 2.3
126 11.2 20 1.8
157 14.0 29 2.6
200 17.8 39 3.5
186 16.6 28 2.5
136 12.1 25 2.2
111 9.9 22 2.0
128 11.4 22 2.0 9.1 2
111 9.9 14 1.2 — —
94 8.4 22 2.0 13.7 3
Received 28 August 2014. Revision requested 16 September 2014. Accepted for publication 22 September 2014 1
Intensive Care Unit, Centro de Investigaciones Medico Quirurgicas, La Habana, Cuba.
The author declares no funding or conflicts of interest. Correspondence: Anselmo Abdo, PhD, MD, Centro de Investigaciones Medico Quirurgicas, Calle 216 y 11B, Reparto Siboney, Playa, Aptdo. 6096, La Habana, Cuba. ([email protected]) Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0041-1337/15/9902–e10 DOI: 10.1097/TP.0000000000000505
e10
www.transplantjournal.com
Transplantation
■
February 2015
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
■
Volume 99
■
Number 2
Liver Transplantation in Latin America Anselmo Abdo
I
would like to bring to our attention the data on liver transplantation in Cuba to supplement the recent article on liver transplantation in Latin America.1 The 11.2 million inhabitants of Cuba have full access to universal public health care coverage, including organ transplantation and immunosuppressive drugs. Legislation supports organ donation after the diagnosis of brain death,2 and since 1982, Cuban citizens have had the opportunity on their identity cards to affirm or deny their wishes for organ donation after death. The National Transplant Office, which is directly linked to the Ministry of Health, was formed in 2002 to emulate the organizational structure of the Spanish model.3 The deceaseddonor organ donation rate was 9.9 per million population (pmp) in 2012 (Table 1). Refusal to donate was seen in only 8.6 % in 2012, which is one of the lowest rates in Latin America.4 The average age of organ donors was 44.6 years, with cerebrovascular disease as the main cause of brain death. The first liver transplantation in Cuba was performed in 1986, but it was not until July 3, 1999, that the liver transplantation program commenced fully.5 The procedures are performed in 3 hospitals (one of them a pediatric hospital, since 2004). We have transplanted 361 livers (3 simultaneous liver-kidney) since 1986 in these 3 centers and have also undertaken living related donor liver transplantation since 2011. On average, the rate of liver transplantation is 1.8 pmp (Table 1), and there were 26 people awaiting a liver at the end of 2012. Hepatitis C and alcoholic cirrhosis are the main adult diagnoses, whereas biliary atresia is the main cause of pediatric liver transplantation. The organ allocation systems give priority to pediatric patients, those with acute liver failure, or
those who need retransplantation. The Model for End-Stage Liver Disease system establishes priority on the waiting list. The 1-year survival for adult patients who underwent transplantation for chronic liver diseases was 73.7% but only 40% for those with acute liver failure.5 There have been 3 successful pregnancies, and the longest survivor to date has been transplanted for 13 years. Additional information is available at www.sld.cu/sitios/trasplante. The Transplantation Section of the Cuban Surgery Society welcomes membership by any health professional involved in transplantation and endorses the Declaration of Istanbul. Starting and maintaining a liver transplantation program is extremely challenging in countries with emerging economies. I agree with the need expressed in this article1 for a Latin American registry to act as a focus for research and regional cooperation. REFERENCES 1. Salvalaggio PR, Caicedo JC, de Albuquerque LC, et al. Liver transplantation in Latin America: the state-of-the-art and future trends. Transplantation 2014;98:241. 2. Legislación sobre donación y trasplante de órganos, tejidos y células: compilación y análisis comparado. Washington, DC: OPS, 2013. http:// www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid= 21392&Itemid=. Accessed August 13, 2014. 3. Abdo A, Ugarte JC, Castellanos R, et al. The transplantation donation process in the Centro de Investigaciones Medico Quirurgicas of Cuba: 1999–2002. Transplant Proc 2003;35:1636. 4. International Figures on Donation and Transplantation—2012. Vol 18. No 1. September 2013. Newsletter Transplant. www.ont.es/publicaciones/ Documents/newsletter_transplant_vol_18_no_1_september_2013.pdf. Accessed August 13, 2014. 5. González L, Abdo AA, López O, et al. First 100 liver transplants at the medico-surgical research center (CIMEQ). Transplant Proc 2006;38: 2473.
TABLE 1.
Number of actual deceased donors per year and liver transplantations performed in Cuba, 1999–2013 Year
Actual deceased donors, n Actual deceased donors, pmp Liver transplantation, n Liver transplantation, pmp Living-donor liver transplantation, % Living-donor liver transplantation, n
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
46 4.1 6 0.5
61 5.4 9 0.8
84 7.5 14 1.2
222 19.8 24 2.1
194 17.3 29 2.6
159 14.2 26 2.3
126 11.2 20 1.8
157 14.0 29 2.6
200 17.8 39 3.5
186 16.6 28 2.5
136 12.1 25 2.2
111 9.9 22 2.0
128 11.4 22 2.0 9.1 2
111 9.9 14 1.2 — —
94 8.4 22 2.0 13.7 3
Received 28 August 2014. Revision requested 16 September 2014. Accepted for publication 22 September 2014 1
Intensive Care Unit, Centro de Investigaciones Medico Quirurgicas, La Habana, Cuba.
The author declares no funding or conflicts of interest. Correspondence: Anselmo Abdo, PhD, MD, Centro de Investigaciones Medico Quirurgicas, Calle 216 y 11B, Reparto Siboney, Playa, Aptdo. 6096, La Habana, Cuba. ([email protected]) Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0041-1337/15/9902–e10 DOI: 10.1097/TP.0000000000000505
e10
www.transplantjournal.com
Transplantation
■
February 2015
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
■
Volume 99
■
Number 2
