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Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt
Published on: May 7, 2015
Experience of a successful pediatric liver transplant program in Mexico
G Varela-Fascinetto1, R Dávila-Pérez, J Nieto-Zermeño
1Department of Transplantation, Hospital Infantil de México Federico Gómez, México City, Mexico. varelafas@aol.com
Abstract:
Orthotopic liver transplantation (OLT) has been very difficult to develop in Mexico and for many years its occurrence was anecdotal. This report presents the results of a pediatric liver transplant program, analyzing the variables that affect outcomes. Between June 1998 and March 2004, 35 OLT were performed in 34 recipients including 80% cadaveric whole-organ grafts and 20% segmental grafts, with 11% from cadaveric and 9% from living donors. Most of the recipients were infants or toddlers weighing less than 15 kg. There was only 1 case of arterial thrombosis (2.8%); the graft was saved with a Kasai procedure. Biliary complications were present in 22% of cases, all resolved with reoperations. Posttransplant cytomegalovirus infection or reactivation (28%), acute rejection (25%), or posttransplant lymphoproliferative disorders (5.7%) were not a cause of graft or patient loss. Overall, 1- and 5-year patient survival rates are 77.1% and 74.2%, respectively; however, when the 1998-2000 cohort was compared with the 2001-2004 cohort, there was a significant difference in survival (P = .004). The 1-year patient survival for the later group is 91.6%. We performed the first successful living donor liver transplantation and the first simultaneous liver-kidney transplantation in a child in our country. Our results demonstrate that pediatric liver transplantation is a feasible undertaking in Mexico, with survival rates comparable to those of foreign centers.
Insights
Pediatric liver transplantation in Mexico is now feasible, with survival rates improving significantly over time. Early outcomes show promising results, comparable to international standards.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplant Immunology
Background:
- Orthotopic liver transplantation (OLT) in Mexico was historically limited, with few documented cases.
- Developing a pediatric liver transplant program requires addressing specific challenges in a developing healthcare system.
Purpose of the Study:
- To present the outcomes of a pediatric liver transplant program in Mexico.
- To analyze variables impacting patient and graft survival in pediatric OLT.
- To establish the feasibility of pediatric liver transplantation in Mexico.
Main Methods:
- Retrospective analysis of 35 pediatric orthotopic liver transplantations performed between June 1998 and March 2004.
- Inclusion of data on graft types (whole vs. segmental, cadaveric vs. living donor), recipient demographics, and post-transplant complications.
- Comparison of survival rates between early (1998-2000) and later (2001-2004) cohorts.
Main Results:
- Overall 1- and 5-year patient survival rates were 77.1% and 74.2%, respectively.
- Significant improvement in 1-year survival from the earlier to the later cohort (91.6% in 2001-2004, P = .004).
- Low rates of arterial thrombosis (2.8%) and successful management of biliary complications (22%); common post-transplant issues like CMV, rejection, and PTLD did not lead to graft loss.
Conclusions:
- Pediatric liver transplantation is a viable procedure in Mexico, achieving survival rates comparable to international centers.
- Improvements in surgical techniques and post-operative care have led to significantly better outcomes over time.
- The program successfully performed the first living donor liver transplant and simultaneous liver-kidney transplant in a child in Mexico.
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