title: Consensus, Dilemmas, and Challenges in Living Donor Liver Transplantation in Latin America.
abstract: We reviewed the history, volume, outcomes, uniqueness, and challenges of living donor liver transplantation (LDLT) in Latin America. We used the data from the Latin American and Caribbean Transplant Society, local transplant societies, and opinions from local transplant experts. There are more than 160 active liver transplant teams in Latin America, but only 30 centers have used LDLT in the past 2 years. In 2014, 226 LDLTs were done in the region (8.5% of liver transplant activities). Living donor liver transplantation is mainly restricted to pediatric patients. Adult-to-adult LDLT activities decreased after the implementation of the model for end-stage liver disease score and a concomitant increase on the rate of deceased donors per million population. Posttransplant outcome analysis is not mandatory, transparent or regulated in most countries. More experienced teams have outcomes comparable to international expert centers, but donor and recipient morbidity might be underreported. Latin America lags behind in terms of the number of adult LDLT and the rate of living donor utilization in comparison with other continents with similar donation rates. Local alliances and collaborations with major transplant centers in the developed world will contribute to the development of LDLT in Latin America.
authors.affiliation: 1 Liver Transplant Center, Hospital Israelita Albert Einstein, São Paulo, Brazil. 2 Liver Transplant Center, Hospital Sírio-Libanes, São Paulo, Brazil. 3 Liver Transplant Center, AC Camargo Cancer Center, São Paulo, Brazil. 4 Department of Surgery, Universidade de São Paulo, São Paulo, Brazil. 5 Department of Surgery, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil. 6 Division of Renal Transplantation, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil. 7 Liver Transplant Center, Hospital Británico, Buenos Aires, Argentina. 8 Liver Transplant Center, Centro Estadual de Transplante, Rio de Janeiro, Brazil. 9 Liver Transplant Center, Fundácion Vale de Lilli, Cali, Colombia. 10 Liver Transplant Center, Center CCSS-Hospital México, San Jose, Costa Rica. 11 Liver Transplant Center, Hospital Infantil de México Federico Gómez, Ciudad de Mexico, Mexico. 12 Department of Surgery, Universidad Católica de Chile, Santiago, Chile.
authors.forename: Paolo R
authors.initials: PR
authors.lastname: Salvalaggio
authors.forename: João
authors.initials: J
authors.lastname: Seda Neto
authors.forename: Jefferson Andre
authors.initials: JA
authors.lastname: Alves
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Fonseca
authors.forename: Luiz
authors.initials: L
authors.lastname: Carneiro de Albuquerque
authors.forename: Wellington
authors.initials: W
authors.lastname: Andraus
authors.forename: Paulo B
authors.initials: PB
authors.lastname: Massarollo
authors.forename: Valter
authors.initials: V
authors.lastname: Duro Garcia
authors.forename: Rafael J
authors.initials: RJ
authors.lastname: Maurette
authors.forename: Andrés E
authors.initials: AE
authors.lastname: Ruf
authors.forename: Lucio F
authors.initials: LF
authors.lastname: Pacheco-Moreira
authors.forename: Luis A
authors.initials: LA
authors.lastname: Caicedo Rusca
authors.forename: Veronica Botero
authors.initials: VB
authors.lastname: Osorio
authors.forename: Maria Amalia
authors.initials: MA
authors.lastname: Matamoros
authors.forename: Gustavo
authors.initials: G
authors.lastname: Varela-Fascinetto
authors.forename: Nicolas P
authors.initials: NP
authors.lastname: Jarufe
mesh_terms: D001938:Brazil; D058625:End Stage Liver Disease / Q000208:ethnology / Q000601:surgery*; D006801:Humans; D007373:Interinstitutional Relations; D007391:International Cooperation; D007843:Latin America; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D012720:Severity of Illness Index; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome