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Building Equity Through Experience: Insights From 1560 Single-Center Pediatric Liver Transplants in a Developing

João Seda Neto1,2,3, Paulo Chapchap1, Eduardo A Fonseca1,2,3

  • 1Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil.

Pediatric Transplantation
|November 6, 2025
PubMed

Insights

A São Paulo transplant team achieved excellent pediatric liver transplant (PLT) outcomes, performing 1560 procedures over 34 years. Despite success, challenges like underfunding and access disparities persist in low- and middle-income countries.

Area of Science:

  • Hepatology
  • Transplant Surgery
  • Pediatric Gastroenterology

Background:

  • A single transplant center in São Paulo, Brazil, has accumulated extensive experience in pediatric liver transplantation (PLT) over 34 years.
  • The center has performed 1560 PLTs, including living donor liver transplants (LDLT), deceased donor liver transplants (DDT), and domino procedures.
  • Recent outcomes in a cohort of 500 PLTs (2018-2024) demonstrate high 1- and 5-year patient survival rates of 96.7% and 94.8%.

Purpose of the Study:

  • To report the long-term outcomes and experience of a high-volume pediatric liver transplant program in a low- and middle-income country.
  • To highlight the center's significant contribution to PLT in Brazil, particularly for young children.
  • To identify and discuss key barriers to sustainable and equitable PLT development in Brazil and propose guiding principles.

Main Methods:

  • Retrospective analysis of pediatric liver transplant data from a single center over 34 years.
  • Detailed review of patient survival rates and procedure types, including LDLT, DDT, and domino procedures.
  • Analysis of the center's contribution to national PLT statistics and identification of systemic challenges.

Main Results:

  • Over 34 years, 1560 pediatric liver transplants were performed, with 1352 LDLT, 179 DDT, and 29 domino procedures.
  • In the most recent cohort (2018-2024), 1- and 5-year patient survival rates were 96.7% and 94.8%, respectively.
  • The center performed 35.1% of all PLTs in Brazil from 2015-2024, and 45.5% of those in children under 5, with 98.1% utilizing LDLT.

Conclusions:

  • Excellent long-term outcomes in pediatric liver transplantation are achievable even in resource-constrained settings.
  • Significant structural challenges, including underfunding and access disparities, hinder equitable PLT development in Brazil.
  • Institutional commitment, strategic investment, and national coordination are crucial for advancing pediatric liver transplantation and ensuring equitable access.

Keywords:
childrenfinancingliver transplantationoutcomessurvival

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