[Pediatric liver transplant program at Hospital Infantil de Mexico Federico Gomez].
This article reports the experience of the largest pediatric liver transplant (LT) program in México. Between June 1998 and May 2011, 76 LT were performed in 74 recipients, including 80% cadaveric-whole organ grafts and 20% segmental grafts, 12% of those coming from live donors and 8% from cadaver reduced donors. The most common indication for LT was biliary atresia (43%), followed by metabolic disorders (13%) and fulminant hepatitis (12%). Most of the recipients were infants or toddlers weighing <15 kg (age range 0.7-17.2 years, weight range 6.5-66 kg), 73% had moderate to severe malnutrition and 72% had multiples surgeries previous to LT. There were 9 cases of hepatic artery thrombosis (11.8%) and 2 portal vein thrombosis (2.6%), however, 8 of these 10 grafts were rescued with early thrombectomy and reanastomosis. All biliary complications (19 cases, 25%) were solved with medical or surgical interventions and did not cause any graft loss. Acute cellular rejection (30 cases, 39%) required thymoglobulin in only 3 cases and chronic rejection (4 cases, 5%) has been retransplanted in 2 cases. CMV infection or reactivation occurred in 30% of cases and easily responded to preemptive therapy. Nine recipients developed postLT neoplasias (7 post-transplant lymphoproliferative disorders, one multivisceral Kaposi sarcoma and one systemic smooth muscle tumor). Five of them responded to decreasing or discontinuing immunosuppression, and 2 are completely tolerant to the graft. The one and five-year patient survival for those LT performed during 2001-2011 was 85 and 75%. The first successful live donor LT in the country was performed in 2001 at this program, as was the first simultaneous liver-kidney transplant in a child. This is the largest and most successful pediatric LT series in the country. Our results demonstrate that pediatric LT is a feasible undertaking in Mexico, with survival rates similar to those of foreign centers.
Departamento de Trasplantes, Hospital Infantil de Mexico Federico Gómez, DF México. varelafas@aol.com
Gustavo
G
Varela-Fascinetto
J Alejandro
JA
Hernández-Plata
Jaime
J
Nieto-Zermeño
J Manuel
JM
Alcántar-Fierros
Victor
V
Fuentes-García
Pedro
P
Castañeda-Martínez
Pedro
P
Valencia-Mayoral
J Manuel
JM
Salgado-Ramírez
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data*; D008297:Male; D008800:Mexico; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology