Mohamed Eissa, MD, Vincent Bain, MD University of Alberta, Edmonton, AB, Canada
Introduction: Liver transplantation of foreign nationals (FNLT) who acutely decompensate remains to be an ethical dilemma that many Canadian transplant centres face. We present a case report of a cirrhotic foreign national who acutely decompensated in Alberta, Canada requiring liver transplantation.
Case Description/Methods: a 57-year-old female from Vietnam with chronic Hepatitis B (HBV) infection who was visiting family members in Alberta, Canada was admitted to hospital with liver failure secondary to reactivation of HBV. She was previously on tenofovir but was stopped due to financial reasons. She failed to respond to medical management including anti-viral therapies in-hospital and a decision was made to proceed with liver transplantation. She received a donation after cardiac death (DCD) liver with post-op complications including hepatic artery thrombosis (HAT) managed conservatively with heparin, and post-transplant diabetes managed with diabetic diet. The liver explant showed cirrhosis and severe hepatitis. Patient currently remains on a visitor visa in Canada, with plans for extending her stay and is paying out-of-pocket for all medications due to lack of insurance. Long-term plan includes life-long entecavir for HBV and aspirin for HAT, monthly intramuscular injections of Hepatitis B immunoglobulin (HBIG) and mycophenolic acid for the first 12 months post-transplant and a generic form of tacrolimus.
Discussion: Literature shows that many transplant programs in Canada will consider patients for transplant based on medical needs despite foreign nationality. The Canadian Liver Transplant Network has a consensus of accepting FNLT based on emergent need. Previously it permitted up to a maximum of 5% of the total available cadaveric livers. There remains challenges including lack of awareness among hepatologists of the existence of such consensus and obtaining financial coverage on a provincial level. This case report will hopefully generate a discussion and raise awareness on guidelines around FNLT in Canada.
Disclosures:
Mohamed Eissa indicated no relevant financial relationships.
Vincent Bain indicated no relevant financial relationships.
Mohamed Eissa, MD, Vincent Bain, MD. P2537 - Liver Transplantation of a Foreign National With Acute Liver Failure Secondary to Chronic Hepatitis B Reactivation in Canada: A Case Report, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
