Pediatric Liver Transplantation: Ten Years of Experience in a Multicentric Program in Chile

• Published in: Transplantation proceedings Vol. 37; no. 8; pp. 3375 - 3377
• Main Authors: Uribe, M., Buckel, E., Ferrario, M., Godoy, J., González, G., Hunter, B., Ceresa, S., Cavallieri, S., Berwart, F., Herzog, C., Santander, M.T., Calabrán, L.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2005; Elsevier Science
• Subjects: Adolescent; Bacterial Infections - epidemiology; Biological and medical sciences; Child; Child, Preschool; Chile; Cytomegalovirus Infections - epidemiology; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunosuppressive Agents - therapeutic use; Infant; Liver Failure; Liver Transplantation - immunology; Liver Transplantation - mortality; Liver Transplantation - physiology; Male; Medical sciences; Postoperative Complications - epidemiology; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Analysis; Tissue, organ and graft immunology; South America; Chile; America; Human; Pediatrics; Program; Digestive system; Liver; Transplantation; Homotransplantation; Medicine; Experience; Treatment; Surgery; Graft; Child
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2005.09.096

Liver transplantation is the only treatment for patients with terminal acute and chronic diseases. Liver transplantation was started in Chile in 1985; our pediatric program began in 1993. The aim of this paper work was to present our experience from 1993 through 2004. One hundred and thirty two orthotopic liver transplants (OLT) were performed in children of mean age 5 years and median age 4 years (8 months to 15 years). The most frequent indications were biliary atresia, (43.1%) and acute liver failure (ALF; 20.4%), whose frequent cause was unknown but viral hepatitis A was the second one. A complete liver was transplanted in 59 patients, reduced in 39, split in one, and as an auxiliary liver in another one. Living related liver transplantation was performed in 32 cases (24.2%), of which thirty included segments II and III, and two, a right liver. A terminal arterial anastomosis was performed in 102 (77.2%) recipients and a graft interposition in 32 patients (24.2%). In 16 cases, biliary reconstruction was performed through an enterobiliary anastomosis. Immunosuppression included cyclosporine (Neoral), steroids, and azathioprine with conversion to tacrolimus (Prograf) as indicated. Rejection episodes, which were always biopsy-proven, were treated either with methylprednisolone or with antibodies. Biliary complications were the most frequent (21.4%) and the second cause was vascular complications (13%). Sixty-six patients suffered an acute rejection episode. Actuarial graft survival was 81.3% at 1 year and 72% at 5 years, while actuarial graft survival for ALF was 75.9% at 1 year and 67.8% at 5 years. Our results are comparable to those reported by most international groups.