Background: The Arab world comprises the 22 countries of the League of Arab States founded in 1945. The Arab world has a combined population of around 422 million people and is united by Arabic language, culture, religion and geographic contiguity. The high prevalence of viral hepatitis in certain Arab countries has led to an increasing number of patients suffering from end-stage liver disease and who are in need for liver transplantation (LT). The first deceased donor liver transplant (DDLT) in the Arab World was performed in 1990 at Riyadh Military Hospital in Saudi Arabia; and the first Living Donor Liver transplant (LDLT) was performed in 1991 at the National Liver Institute in Egypt. Since then, both DDLT and LDLT have been routinely performed in many Arab countries. Herein, we summarize the liver transplant activity in the Arab World.

Material and Methods: After extensive search, liver transplant activities were found in 11 Arab countries and divided between 27 liver transplant centers. In June 2012, an email questionnaire was sent to all 27 centers requesting simple information including; date of the first LT, total number of LT, number of DDLT, number of LDLT, in addition to the most common indication for LT in those centers.

Results: Out of 27 liver transplant centers, 26 centers (96.3%) responded to the questionnaire and agreed to provide their data. Up to June 2012, a total of 3207 liver transplants were performed in the Arab World divided between 11 countries and 26 transplant centers. Out of the 3207 liver transplants, 2550 (79.5%) were LDLT and 657 (20.5%) were DDLT. The highest LT activity was found in Egypt (56%) mostly performing LDLT, followed by Saudi Arabia (35%) performing both DDLT and LDLT, and finally Jordan (5%) mostly performing LDLT. The most common indication for LT was end-stage liver cirrhosis due to Hepatitis C virus (HCV) or Hepatitis B virus (HBV), with or without Hepatocellular Carcinoma (HCC). Liver transplantation activity in the Arab World is summarized in the table below.

Conclusions: Both DDLT and LDLT have been routinely and successfully performed in the Arab World. As elsewhere, severe organ shortage remains the biggest hurdle facing the increasing need for LT in most of the Arab countries. Although deceased organ donation has been legalized in many Arab countries, its implementation remains limited to few countries mostly due to cultural and logistical barriers. The increasing demand and limited supply of organs in the Arab World has generated many concerns especially related to organ trafficking and transplant tourism. These shared challenges can only be faced through continued collaboration between various liver transplant programs in the Arab World. The Pan Arab Liver Transplant Society (PALTS) is developing a comprehensive registry and an online forum aiming to discuss all shared problems related to liver transplantation in the Arab World including medical, ethical, social and legal aspects.