S2707 Trends in Liver Transplantation in Peru: A Five-Year National Analysis (2019–2024)

Introduction: In recent years, liver diseases have increasingly burdened healthcare systems across Latin America. Liver transplantation (LT) remains the only curative option for patients with decompensated cirrhosis and acute liver failure. However, in Peru, the development of LT programs faces significant structural challenges, including low organ donation rates, a fragmented healthcare system, and limited access to specialized care. This study examines national trends in liver transplantation in Peru between 2019 and 2024. Methods: We conducted a descriptive analysis of LT in Peru using national registry data from 2019 to 2024. Trends were stratified by donor type (living vs deceased) and age group (adult vs pediatric). Transplant rates per million population (pmp) were standardized with World Bank data. Recipient characteristics (age, sex, and healthcare institution type) were also analyzed. Results: Following a sharp decline during the COVID-19 pandemic, LT rates in Peru showed a progressive recovery. In 2019, the national LT rate was 1.63 transplants pmp, dropping to 0.52 pmp in 2020 and remaining low in 2021 (0.69 pmp). From 2022 onward, a sustained recovery was observed, reaching 1.11 pmp in 2022, 1.27 in 2023, and 1.38 in 2024. Deceased donor LTs accounted for the majority of procedures throughout the study period (79%). In contrast, living donor LTs represented 21% of total LTs, with consistently low annual rates. The mean age of transplant recipients was 34.2 years (±25.0), ranging from infants under one year to elderly adults. Men accounted for 55% of all recipients, and 99.5% of procedures were performed in Lima. Pediatric LT remained consistently low, ranging from 10 to 20 procedures annually, with a cumulative total of 86 cases. All LTs were conducted in Lima, except for one performed in Junin. Institutionally, EsSalud conducted the majority of procedures, performing 92.7% of all LTs, while MINSA, accounted for 7.3%, all in pediatric patients. Conclusion: Liver transplantation in Peru has shown steady recovery following the impact of the pandemic, yet structural barriers continue to hinder its development. The concentration of procedures in Lima and within the social security system reflects significant inequities in access. These findings underscore the need for public policies aimed at strengthening organ donation, decentralizing transplant services, and expanding pediatric coverage, in pursuit of a more equitable and sustainable transplant system.