Liver transplantation in Thailand: The first report from the Thai Liver Transplant Registry
Chutwichai Tovikkai1, Bunthoon Nonthasoot2, Ake Pugkhem3, Sunhawit Junrungsee4, Goragoch Gesprasert5, Chalermrat Bunchorntavakul6, Somchai Limsrichamrern1, Suporn Treepongkaruna7, Adisorn Lumpaopong8, Thanom Supaporn9, Surazee Prommool10.
1Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 2Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 3Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 4Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 5Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 6Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand; 7Department of Paediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 8Department of Pediatrics, Phramongkutklao College of Medicine, Bangkok, Thailand; 9Department of Medicine, Phramongkutkloa College of Medicine, Bangkok, Thailand; 10Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
The subcommittee for Thai Liver Transplant Registry, Thai Transplant Society.
Background: First liver transplantation in Thailand was performed in 1987. However, systematic data collection has not begun until Thai Liver Transplant Registry was established in 2018 to collect and analyze information of liver transplantation from all liver transplant centers in Thailand.
Methods: Registry data was obtained from all 9 liver transplant centers in Thailand. Recipient, donor and transplant characteristics of all liver transplant in adult patients (age >18 years) in 2016-2018 were described. Patient and graft survival were calculated and reported.
Results: During 2016-2018, there were 251 adult liver transplantation in Thailand, including 14 cases of re-transplantation. Majority is cadaveric liver transplantation (96.4%). Mean age was 55.2 years, and 70.5% were male. Three most common indications were hepatocellular carcinoma (50.2%), hepatitis B (30.7%) and hepatitis C (28.7%). Average MELD-Na score was 20.2. In terms of donor, mean age was 33.8 years, and 83.3% were male. 9.2% of donor needed cardiopulmonary resuscitation. The most common cause of death of donors was traffic-related accident. The common immunosuppressive drugs in induction phase were methylprednisolone (74%), tacrolimus (53%) and mycophenolate sodium (48%), while during maintenance, tacrolimus (56%), mycophenolate mofetil (39%) and prednisolone (39%) were common immunosuppression. Regarding financial support, liver transplantation was reimbursed by civil servant benificiary scheme (48.6%), social insurance scheme(10%), self payment (27.9%) and other financial support (13.5%). Post-transplant 90-day mortality was 7.6%, and 1-year and 2-year patient survival were 88.3% and 85.8%, respectively. The most common causes of death were infection (62%). 1-year and 2-year graft survival were 85.5% and 81.3%, respectively. The most common causes of graft loss included vascular complications (32%) and primary graft non-function (11%).
Conclusion: We reported recipient and donor characteristics of liver transplantation in Thailand. Even though the number is much lower than that in the US and European countries, the patient and graft survival outcome were comparable to those reported in OPTN/SRTR from the US and ELTR registry from Europe.
The authors would like to thank physicians and transplant coordinators from all liver transplant centers in Thailand for providing clinical information to the Thai Liver Transplant Registry..
[1] Adam R, Karam V, Cailliez V, et al. 2018 Annual Report of the European Liver Transplant Registry (ELTR) - 50-year evolution of liver transplantation. Transpl Int 2018; 31: 1293-1317.
[2] Kim WR, Lake JR, Smith JM, et al. OPTN/SRTR 2017 Annual Data Report: Liver. Am J Transplant 2019; 19(Suppl 2): 184-283.
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