Liver transplant and global surgery: Experience establishing a global liver transplantation mentoring program

ABSTRACT

Background: Two million adults and children die each year of liver disease. Liver transplantation (LT) is the second most common solid organ transplantation, however, less than 10% of global transplantation needs are achieved. Low- and Middle-income Countries (LMIC's) are the most affected. A University based Center for Global Surgery and our LT team, started collaborations with counterparts in LMIC's over a decade ago and joined efforts in 2017 to create an international alliance that allows clinical care, education and research endeavors. We aim to describe our experience establishing a LT mentoring group within an academic Center for Global Surgery. Methods: This is a retrospective observational study. We evaluated the number of clinical, research and educational activities that our program did in collaboration with LMIC's for more than a decade (2009 -2022).Surgeries, patient evaluation and follow-up were done in a multidisciplinary fashion with protocols and guidelines from our LT program in partnership with LMIC's LT teams and via telehealth. Most educational and research activities were done online. Results: We performed 15 surgeries in pediatric and adult patients, including cadaveric and living donor LT, portosystemic shunts and resections and evaluated 27 patients from LMIC's. We published 1 article, presented 5 s and obtained 1 grant. Our group received support to sponsor one research scholar per year and we had 15 bilateral exchange visits and organized 27 online multidisciplinary education sessions in collaboration with centers from LMIC'S. Conclusions: Our data shows that global efforts with a multidisciplinary model supported by international societies can have clinical and academic impact. It is feasible to partner and mentor the academic and clinical development of LT programs in LMIC's through telehealth and exchange programs. Funding of these efforts remains challenging, and COVID-19 has limited academic and clinical activities.