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Pediatric liver transplantation experience and outcome in Chile
C Acuña1, R Zuleta, R Dalmazzo
1Hospital Luis Calvo Mackenna, Santiago, Chile.
Insights
Pediatric liver transplantation in Chile has grown significantly, with survival rates improving dramatically in recent years. The introduction of living donor transplants has been crucial in reducing mortality for children awaiting liver transplants.
Area of Science:
- Pediatric Hepatology and Gastroenterology
- Transplant Surgery
- Clinical Outcomes Research
Background:
- The Hospital Luis Calvo Mackenna and Clinica Las Condes have accumulated extensive experience in pediatric liver transplantation since 1994.
- This program represents the largest national experience, establishing the institutions as leading referral centers in both public and private healthcare sectors.
- The study aims to comprehensively report the outcomes of this pediatric liver transplantation program.
Purpose of the Study:
- To present the clinical experience and outcomes of a pediatric liver transplantation program.
- To analyze survival rates, complications, and the impact of surgical techniques, including living donor transplantation.
Main Methods:
- Retrospective review of a pediatric liver transplantation database from January 1994 to July 2011.
- Data collected included patient demographics, indications for transplantation, surgical techniques, complications, and survival.
- Survival rates were analyzed using Kaplan-Meier methods.
Main Results:
- A total of 230 transplantations were performed in 189 pediatric patients; 55% were male, with a mean age of 5 years.
- Biliary atresia (50%), fulminant hepatic failure (25%), and cholestatic diseases (10%) were the primary indications.
- Overall 1-, 5-, and 10-year patient survival rates were 80%, 73%, and 68%, respectively, with survival exceeding 90% in the last 3 years. Living donor transplantation was utilized in 28% of cases.
Conclusions:
- The program accounts for over 90% of Chile's national liver transplant experience.
- The integration of living donor liver transplantation has significantly improved outcomes and reduced waiting list mortality, particularly for acute liver failure.
- Recent survival rates demonstrate marked improvement, comparable to international benchmarks.
Introduction:
In 1994 our group began its experience with pediatric liver transplantation. The experience gained during this period is the largest in the country, positioning the Hospital Luis Calvo Mackenna and Clinica Las Condes as major referral centers in the public and private sectors. The aim of this study was to report our experience of our pediatric liver transplantation program during this period.
Methods:
The liver transplantation database of Hospital Luis Calvo Mackenna and Clinica Las Condes between January 1994 and July 2011 was reviewed recording age, gender, indications for transplantation, surgical technique, complications, and survival. Survival rates were calculated using Kaplan-Meier analysis.
Results:
During the period described 230 transplantations were performed in 189 pediatric patients. Fifty-five percent were male patients. The average age was 5 years. The main causes of transplantation were biliary atresia (50%), fulminant hepatic failure (25%), and other cholestatic diseases by 10%. Vascular and biliary complications were the leading cause of graft loss and retransplantation. The overall rate of retransplantation at 5 years was 20%. The technique of living donor was used in 28% of the cases. The 1-year patient actuarial survival rate was 80%, 73% at 5 years, and 68% at 10 years. In the last 3 years the survival rate at 1 year exceeds 90%.
Discussion:
Our program includes more than 90% of the national liver experience. The incorporation of living donor is a milestone that has enabled us to save many patients who previously died while waiting for an organ. Its use in cases of full acute liver failure has allowed us to dramatically reduce mortality on the waiting list. Our results in the last 3 years reflect the experience that results in a significant decrease in mortality, comparing favorably to other series published in the international literature.
