Skip to main content
SpringerLink
Log in

Experience in Africa

  • Living reference work entry
  • First Online:
Solid Organ Transplantation in Infants and Children

Part of the book series: Organ and Tissue Transplantation ((OTT))

  • 133 Accesses

Abstract

Liver transplantation is the accepted mode of treatment for children with end-stage liver disease or acute liver failure. Long-term outcomes have significantly improved, and the aim of management is no longer only long-term survival, but also focuses on quality of life.

Liver transplantation in Africa faces a number of challenges including wide socioeconomic disparities, shortage of skilled medical personnel and facilities, infectious disease burden, and insecure access to and monitoring of immunosuppression. While there is a need for liver transplantation, the establishment and sustainability of transplant programs require careful planning with national government and institutional support. Appropriate training of the transplant team, development of assessment and treatment protocols, and transparent and equitable criteria for organ allocation are important to establish before embarking on a transplant program.

Establishing sustainable, self-sufficient liver transplant programs with equal access to all citizens including access to living-related liver transplantation for countries with no liver transplant programs is an important step toward curtailing transplant tourism and organ trafficking. Development of liver transplant programs has a further beneficial effect of raising the level of medical and surgical care in these countries.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Akoh JJ (2011) Renal transplantation in developing countries. Saudi J Kidney Dis Transpl 22(4):637–650

    PubMed  Google Scholar 

  • Akoh JA (2012) Key issues in transplant tourism. World J Transplant 2(1):9–18

    Article  PubMed  PubMed Central  Google Scholar 

  • Andries S, Casamayou L, Sempoux C et al (2001) Posttransplant immune hepatitis in pediatric liver transplant recipients: incidence and maintenance therapy with azathioprine. Transplantation 72:267–272

    Article  CAS  PubMed  Google Scholar 

  • Arora N, McKiernan PJ, Beath SV et al (2002) Concomitant basiliximab with low-dose calcineurin inhibitors in children post-liver transplantation. Pediatr Transplant 6:214–218

    Article  CAS  PubMed  Google Scholar 

  • Bahador A, Salahi H, Nikeghbalian S et al (2009) Pediatric liver transplantation in Iran: a 9-year experience. Transplant Proc 41:2864–2867

    Article  CAS  PubMed  Google Scholar 

  • Basso MS, Subramaniam P, Tredger M et al (2011) Sirolimus as renal and immunological rescue agent in pediatric liver transplant recipients. Pediatr Transplant 15(7):722–727

    Article  CAS  PubMed  Google Scholar 

  • Botha JF, Spearman CW, Millar AJ et al (2000) Ten years of liver transplantation at Groote Schuur Hospital. S Afr Med J 90(9):880–883

    CAS  PubMed  Google Scholar 

  • Devictor D, Tissieres P, Bicêtre Hospital Pediatric Transplant Group (2013) Pediatric liver transplantation: where do we stand? Where we are going to? Expert Rev Gastroenterol Hepatol 7(7):629–634

    Article  PubMed  Google Scholar 

  • El Moghazy W, Kashkoush S, O’Hali W, Abdallah K (2015) Long-term outcome after liver transplantation for hepatic schistosomiasis: a single-center experience over 15 years. Liver Transpl 21(1):96–100

    Article  PubMed  Google Scholar 

  • Evans HM, McKiernan PJ, Kelly DA (2005) Mycophenolate mofetil for renal dysfunction after pediatric liver transplantation. Transplantation 79:1575–1580

    Article  CAS  PubMed  Google Scholar 

  • Falkenstein K, Flynn L, Kirkpatrick B et al (2004) Non-compliance in children post-liver transplant. Who are the culprits? Pediatr Transplant 8:233–236

    Article  PubMed  Google Scholar 

  • Harden PN, Walsh G, Bandler N et al (2012) Bridging the gap: an integrated paediatric to adult clinical service for young adults with kidney failure. BMJ 1:344

    Google Scholar 

  • Hoffmann CJ, Thio CL (2007) Clinical implications of HIV and hepatitis B co-infection in Asia and Africa. Lancet Infect Dis 7:402–409

    Article  PubMed  Google Scholar 

  • Huprikar S, Danziger-Isakov L, Ahn J et al (2015) Solid organ transplantation from hepatitis B virus-positive donors: consensus guidelines for recipient management. Am J Transplant 15(5):1162–1172

    Article  CAS  PubMed  Google Scholar 

  • Immunization, Vaccines and Biologicals (IVB Catalogue 2014) World Health Organization. http://www.who.int/immunization/documents/en. Accessed 28 Apr 2015

  • International Summit on Transplant Tourism and Organ Trafficking (2008) The declaration of Istanbul on organ trafficking and transplant tourism. Kidney Int 74:854–859

    Article  Google Scholar 

  • Jiménez-Rivera C, Avitzur Y, Fecteau AH et al (2004) Sirolimus for pediatric liver transplant recipients with post-transplant lymphoproliferative disease and hepatoblastoma. Pediatr Transplant 8(3):243–248

    Article  PubMed  Google Scholar 

  • Kelly DA (1997) Posttransplant growth failure in children. Liver Transpl Surg 3(Suppl 1):S32–S39

    CAS  PubMed  Google Scholar 

  • Kelly DA (2006) Current issues in pediatric transplantation. Pediatr Transplant 10:712–720

    Article  CAS  PubMed  Google Scholar 

  • Kelly D (2011) Safety and efficacy of tacrolimus in pediatric liver recipients. Pediatr Transplant 15(1):19–24

    Article  PubMed  Google Scholar 

  • Kelly D, Wray J (2014) The adolescent liver transplant patient. Clin Liver Dis 18(3):613–632

    Article  PubMed  Google Scholar 

  • Kelly D, Jara P, Rodeck B et al (2004) Tacrolimus and steroids versus ciclosporin microemulsion, steroids, and azathioprine in children undergoing liver transplantation: randomised European multicentre trial. Lancet 364:1054–1061

    Article  CAS  PubMed  Google Scholar 

  • Kerkar N, Hadzić N, Davies ET et al (1988) De-novo autoimmune hepatitis after liver transplantation. Lancet 351:409–413

    Article  Google Scholar 

  • Khalaf H, El-Meteini M, El-Sefi T et al (2005) Evolution of living donor liver transplantation in Egypt. Saudi Med J 26:1394–1397

    PubMed  Google Scholar 

  • Kim WR, Lake JR, Smith JM et al (2016) Liver. Am J Transplant 16(Suppl 2):69–98

    Article  PubMed  Google Scholar 

  • Lee KH, Chun TW, Lim SG et al (2001) Risk for de novo Hepatitis B from antibody to Hepatitis B core antigen-positive donors in liver transplantation in Singapore. Liver Transpl 7:469–470

    Article  CAS  PubMed  Google Scholar 

  • Loveland J, Britz R, Joseph C et al (2014) Paediatric liver transplantation in Johannesburg revisited: 59 transplants and challenges met. S Afr Med J 104(11):799–802

    Article  CAS  PubMed  Google Scholar 

  • Matthews PC, Gerettic A, Gouldera PJR et al (2014) Epidemiology and impact of HIV coinfection with Hepatitis B and Hepatitis C viruses in Sub-Saharan Africa. J Clin Virol 61:20–33

    Article  PubMed  Google Scholar 

  • Mazariegos G, Shneider B, Burton B et al (2014) Liver transplantation for pediatric metabolic disease. Mol Genet Metab 111(4):418–427

    Article  CAS  PubMed  Google Scholar 

  • McDiarmid SV (2000) Liver transplantation: the pediatric challenge. Clin Liver Dis 4(4):879–927

    Article  CAS  PubMed  Google Scholar 

  • McDiarmid SV (2001) Management of the pediatric liver transplant patient. Liver Transplant 7(Suppl 1):S77–86

    Article  CAS  Google Scholar 

  • McDiarmid SV, Anand R, Lindblad AS, Principal Investigators and Institutions of the Studies of Pediatric Liver Transplantation (SPLIT) Research Group (2002) Development of a pediatric end-stage liver disease score to predict poor outcome in children awaiting liver transplantation. Transplantation 74:173–181

    Article  PubMed  Google Scholar 

  • McDiarmid SV, Anand R, Martz K et al (2011) A multivariate analysis of pre-, peri-, and post-transplant factors affecting outcome after pediatric liver transplantation. Ann Surg 254(1):145–154

    Article  PubMed  Google Scholar 

  • Millar AJ, Hamza AF (2012) Liver transplantation in an African setting. Semin Pediatr Surg 21(2):164–171

    Article  PubMed  Google Scholar 

  • Millar AJ, Spearman W, McCulloch M et al (2004) Liver transplantation for children -the Red Cross Children’s Hospital experience. Pediatr Transplant 8:136–144

    Article  CAS  PubMed  Google Scholar 

  • Muller E, White S, Delmonico F (2014) Regional perspective: developing organ transplantation in Sub-Saharan Africa. Transplantation 97(10):975–976

    Article  PubMed  Google Scholar 

  • Neto JS, Carone E, Pugliese RP et al (2010) Modified pediatric end-stage liver disease scoring system and pediatric liver transplantation in Brazil. Liver Transpl 16:426–430

    PubMed  Google Scholar 

  • Abbud-Filho M, Al-Mousawi M, Ali Alobaidli A, et al (2008) Organ trafficking and transplant tourism and commercialism: the Declaration of Istanbul. Lancet 372:5–6

    Google Scholar 

  • Otte JB (2004) Paediatric liver transplantation- a review based on 20 years of personal experience. Transpl Int 17:562–573

    PubMed  Google Scholar 

  • Post DJ, Douglas DD, Mulligan DC (2005) Immunosuppression in liver transplantation. Liver Transpl 11(11):1307–1314

    Article  PubMed  Google Scholar 

  • Quak SH (2009) Liver transplantation in the developing world. Curr Opin Organ Transplant 14(5):540–543

    Article  PubMed  Google Scholar 

  • Reding R, Gras J, Sokal E et al (2003) Steroid-free liver transplantation in children. Lancet 362:2068–2070

    Article  CAS  PubMed  Google Scholar 

  • Reding R, Bourdeaux C, Gras J et al (2004) The paediatric liver transplantation program at the Universite catholique de Louvain. Acta Gastroenterol Belg 67:176–178

    CAS  PubMed  Google Scholar 

  • Rizvi SA, Naqvi SA (1997) Need for increasing transplant activity: a sustainable model for developing countries. Transplant Proc 29:1560–1562

    Article  CAS  PubMed  Google Scholar 

  • Sangare L, Sombie R, Combassere AW et al (2009) Ante-natal transmission of hepatitis B virus in an area of HIV moderate prevalence, Burkina Faso. Bull Soc Pathol Exot 102:226–229

    CAS  PubMed  Google Scholar 

  • Shaw BW Jr (1989) Starting a liver transplant program. Semin Liver Dis 9:159–167

    Article  PubMed  Google Scholar 

  • Shaw BW Jr, Gordon RD, Iwatsuki S et al (1985) Retransplantation of the liver. Semin Liver Dis 5:394–401

    Article  PubMed  PubMed Central  Google Scholar 

  • Sibal A, Rajasekar MR, Soin AS (1999) Liver transplantation in the developing world. Indian J Pediatr 66(Suppl 1):S120–S123

    CAS  PubMed  Google Scholar 

  • Skagen CL, Jou JH, Said A (2011) Risk of de novo hepatitis in liver recipients from hepatitis-B core antibody-positive grafts – a systematic analysis. Clin Transplant 25(3):E243–E249

    Article  PubMed  Google Scholar 

  • Spada M, Petz W, Bertani A et al (2006) Randomized trial of basiliximab induction versus steroid therapy in pediatric liver allograft recipients under tacrolimus immunosuppression. Am J Transplant 6(8):1913–1921

    Article  CAS  PubMed  Google Scholar 

  • Spearman CW, McCulloch MI (2014) Challenges for paediatric transplantation in Africa. Pediatr Transplant 18(7):668–674

    Article  CAS  PubMed  Google Scholar 

  • Spearman CWN, McCulloch M, Millar AJW et al (2006) Liver transplantation at Red Cross War Memorial Children’s Hospital. S Afr Med J 96:960–963

    CAS  PubMed  Google Scholar 

  • Spearman CW, Kahn D, Millar AJ et al (2011) Pregnancy following liver transplantation during childhood and adolescence. Pediatr Transplant 15(7):712–717

    Article  CAS  PubMed  Google Scholar 

  • Sudan DL, Shaw BW Jr, Langnas AN (1998) Causes of late mortality in pediatric liver transplant recipients. Ann Surg 227:289–295

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ullah K, Reza S, Ahmed P et al (2008) Posttransplant infections: single centre experience from the developing world. Int J Infect Dis 12:203–214

    Article  PubMed  Google Scholar 

  • WHO Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. http://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/. Accessed 28 Apr 2015

  • Wong TCL, Fung JYY, Mau Lo C (2013) Prevention of recurrent hepatitis B infection after liver transplantation. Hepatobiliary Pancreat Dis Int 12:465–472

    Article  CAS  PubMed  Google Scholar 

  • World Health Organization Position Paper (2009) Hepatitis B vaccines. WHO Wkly Epidemiol Rec 84(40):405–420. http://www.who.int.wer. Accessed 28 Apr 2015

  • Zhu FC, Zhang J, Zhang XF et al (2010) Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomised, double-blind placebo-controlled, phase 3 trial. Lancet 376:895–902

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa

    C. W. N. Spearman

  2. Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa

    C. W. N. Spearman

  3. Department of Paediatric Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

    A. J. W. Millar

  4. Faculty of Health Sciences, Red Cross Children’s Hospital, University of Cape Town, Cape Town, South Africa

    C. W. N. Spearman & A. J. W. Millar

Authors
  1. C. W. N. Spearman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. J. W. Millar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to C. W. N. Spearman or A. J. W. Millar .

Editor information

Editors and Affiliations

  1. Jefferson Medical College, AI Dupont Hospital for Children Department of Surgery, Wilmington, Delaware, USA

    Stephen P. Dunn

  2. Liver & Intestine Transplantation, Seattle Children’s Hospital Liver & Intestine Transplantation, Seattle, Washington, USA

    Simon Horslen

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing AG

About this entry

Cite this entry

Spearman, C.W.N., Millar, A.J.W. (2016). Experience in Africa. In: Dunn, S., Horslen, S. (eds) Solid Organ Transplantation in Infants and Children. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-08049-9_15-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-08049-9_15-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Online ISBN: 978-3-319-08049-9

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation