Factors impeding the practice of liver transplantation in west Africa

Abstract

Background: The burden of liver disease is increasing globally due to the rising prevalence of its risk factors. This is particularly true in West Africa where hepatitis B virus (HBV) is endemic. Since liver transplantation (LT) was established as a definitive treatment for end-stage liver disease, the centers for liver transplantation have expanded significantly. Apart from South Africa and North Africa, there are no facilities for LT in West Africa. The aim of this study was to determine the factors impeding the practice of liver transplantation amongst hepatologists in West Africa.

Methods: This was a questionnaire- based cross-sectional descriptive study conducted among hepatologists in West Africa during a regional hepatitis conference in 2015.

Results: Twenty-four hepatologists completed the questionnaire. They were from Nigeria (42%), Ghana (21%), Cameroon (21%) and Ivory Coast (17%) . The indication for LT in their practice was mostly Chronic HBVinfection and its complications (88%). Although there are no facilities for LT in West Africa, late presentation and financial constraints were the major reasons why patients were not referred outside the region for the procedure. More than 70% believe that factors impeding LT in West Africa are multi-factorial and mostly related to funding, infrastructure and lack of organ donation network.

Conclusion: There are no facilities for LT in West Africa. Hepatologists are unable to access LT in other Countries for their patients mostly because of late presentation and cost implications.Establishment of a regional liver transplant center for capacity building is desirable.

Keywords: Liver transplantation, West Africa