Development of a pediatric liver transplantation program in Argentina

This article describes the preliminary experimental steps and clinical implementation of a purely pediatric liver transplantation (LT) program in a large public children's hospital in Buenos Aires, Argentina, a city with well over 10 million inhabitants and a referral population of over 30 mill...

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Bibliographic Details
Published in:	Pediatric surgery international 1998-07, Vol.13 (5-6), p.319-322
Main Authors:	WILLIAMS, E, QUESTA, H, WACHOLDER, V, ROJAS, L, CERVIO, G, BIANCO, G, IMVENTARZA, O
Format:	Article
Language:	eng
Subjects:	Argentina Biological and medical sciences Child Humans Liver Failure, Acute - etiology Liver Failure, Acute - surgery Liver Transplantation - mortality Liver Transplantation - standards Liver, biliary tract, pancreas, portal circulation, spleen Male Medical sciences Program Development Retrospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Survival Rate Tissue Donors Tropical medicine
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Summary:	This article describes the preliminary experimental steps and clinical implementation of a purely pediatric liver transplantation (LT) program in a large public children's hospital in Buenos Aires, Argentina, a city with well over 10 million inhabitants and a referral population of over 30 million. Between 1993 and 1997, 84 LTs were performed in 81 patients, of which one-fourth weighed below 10 kg. The main indications were biliary atresia (n = 25, 30%) and fulminant liver failure (n = 23, 27%), followed by autoimmune cirrhosis (n = 14, 16%) and other liver diseases. Shortage of organs due to local conditions led to the use of liver-reduction techniques in 48 cases (57%), split liver in 2, and living-related donor (LRD) in 2. Retransplantation was necessary in 3 instances. Seventy-eight percent of the recipients survived for more than 1 year and 71% were alive after 4 years. The authors comment on the need for adaptation to local conditioning factors when developing a pediatric LT program in any country in which demographics and economic, medical, and sociological environments have a decisive influence on organ procurement, the actual performance of the operation, and the lifelong postoperative medication. In Buenos Aires, where the hospital setting is well-developed, the indications are in part determined by the high incidence of hepatitis A. Organ shortages in our area led to liberal use of liver reduction, split-liver, and LRD techniques. The overall results of the first years of such a program were largely satisfactory.
ISSN:	0179-0358 1437-9813