ETHICS, PUBLIC POLICY AND ECONOMICS

H. Wang, S. Fan
Department Of Surgery, THE UNIVERSITY OF HONG KONG, HONG KONG/HONG KONG

Body: Introduction The China Liver Transplant Registry (CLTR) is the official national scientific registry for liver transplantation in China. The University of Hong Kong was authorized by 21 liver transplant centers in China in 2005 and subsequently by the Ministry of Health, China in 2008 to conduct the registry. All liver transplant centers in China are obliged to report data to the CLTR. Methods Prospective collection of data is performed through a computer network. Cutting-edge technologies were implemented to ensure data quality. The data are further verified by on-site checking of hospital records by the personnel of The University of Hong Kong. Results From 1993 to 2008, 11,888 adult (³ 18 years old) liver transplant operations performed at 61 hospitals were recorded in the Registry. The majority of the transplants were performed in the last 6 years. The organs were derived from non-heart-beating donors (n=11,030), brain-stem dead donors (n=85) and living donors (n=773). Male patients predominated (85.1%). Malignant tumors were documented in 49.5% of the explants. The hospital mortality rate was 8.8%. The median follow-up duration was 9.4 months (range 0–118.3 months). The 1-, 3- and 5-year survival rates were 73.7%, 60.1% and 55.6%, respectively. There was an improvement of overall survival rates over the years (p<0.001). Compared with the patients with benign disease, patients with malignant disease had less favorable survival (5-year survival rate of 41.7% vs. 67.8%, p<0.001). For patients with tumor status within the Milan criteria (n=1,905, 46.4%), the estimated 5-year survival rate was 60.4% and was higher than that of those with tumor status beyond the Milan criteria (n=2,200, 53.6%, 5-year survival rate of 32.3%). Living donor liver transplantation emerged as a major treatment method in the last 2 years after the Ministry of Health, China has implemented stringent organ donation policies. The 1-year survival rate of patients receiving living donor liver transplantation was 83.9%, which was higher than that of those receiving deceased donor liver transplantation in the same period. Conclusion The CLTR is now the third largest database for liver transplantation in the world. The Registry has documented a change in the practice of liver transplantation in China. Living donor and brain-stem death organ donations are emerging. The practice of liver transplantation is expected to conform to that of the rest of world in the coming future.

Disclosure: All authors have declared no conflicts of interest.