Pediatric liver transplantation experience and outcome in Chile.

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.

Living donor liver transplantation in pediatric patients with acute liver failure: safe and effective alternative.

UNLABELLED: Living donor liver transplantation (LDLT) for patients with acute liver failure (ALF) is still controversial. To be considered a feasible alternative, this therapeutic option should offer similar results to transplants performed with cadaveric grafts, without significant risks for donors. The aim of this study was to compare the outcomes of pediatric patients with ALF who were transplanted with either cadaveric or living donor grafts. PATIENTS AND METHODS: Between March 1994 and February 2007, 149 patients under 18 years were transplanted, including 43 (28.8%) with ALF. We reviewed the demography, etiology, surgical technique, complications, and long-term results in this group. Patient actuarial survival was determined by Kaplan-Meier analysis. RESULTS: The median age of the recipients was 4.8 years (range 1.2 to 18) including 26 boys and 17 girls. Sixteen (37.2%) underwent LDLT. Three patients in the living donor group needed a second graft (18.7%) versus 7 (26%) among the cadaveric group. No mortality or serious morbidity was observed in living donors. Fifteen patients died. Septic and neurologic complications, and primary graft non-function were the most frequent causes of death. All patients died during the first year after liver transplant. Actuarial 1- and 5-year survivals were 65% without a significant difference between the groups. CONCLUSION: Considering that patients with ALF have no chance of survival without transplantation and that cadaveric grafts remain a limited resource, especially in our country, these results showed that LDLT was a valid option for these patients, as well as a secure procedure for the donors.

[Blood group P1 and its relation to renal cicatrix in patients with urinary infection]. / Grupo sanguíneo P1 y su reláción con cicatriz renal en pacientes con infección urinaria.

Possible relationships between renal scars and P blood group have been recently emphasized. Urinary tract infections, an important factor in the production of renal scar, are mainly caused by specific types of E. coli, which has the ability to adhere through fimbriae, to receptors of the urinary tract epithelium that are structurally related to antigens detected in people with blood group P1. We looked for P1 sub-group in 30 children with vesicoureteral reflux and renal scar and 30 patients with equivalent degrees of reflux but without evidence of renal scar. Sex and age were unmatched. The frequency of P1 blood sub-group was similar in both kinds of patients (56.7% vs. 66.7, n.s.) so we could not demonstrate that P1 sub-group can be a useful indirect risk marker for renal scar formation.

Intra-arterial cisplatin given prior to surgery in osteosarcoma: grade of necrosis and size of tumor as major prognostic factors.

From January 1983 to August 1987, 29 evaluable patients with high-grade osteosarcoma were treated in our institution with preoperative intra-atrial cisplatin, 100 mg/m2 every 14 days for three courses. Surgery was done on day 42. Surgery consisted of limb salvage in six, amputations in 15, and disarticulations in eight. Postoperative chemotherapy included Adriamycin (ADR), 45 mg/m2 for 2 days every 6 weeks, alternated with cisplatin 120 mg/m2 every 6 weeks. The nephrotoxicity (18 out 29) was reversible in all cases. Cardiotoxicity was prominent; it was observed in 31% of patients. In six, there was congestive heart failure, but there were no fatal cases. The hematological toxicity was severe. There were three patients with fatal infections who had no evidence of disease after they had finished treatment. Seventeen of 29 patients (58.6%) were good responders and showed 60-100% tumoral necrosis after intra-atrial cisplatin. The 6-year, relapse-free survival rate was 58.6%--70.5% for the good responders and 41.6% for the poor responders (p less than 0.05). The size of the tumor was the other important prognostic factor. The rate of 6-year, relapse-free survival was 73.6% for small tumors (those measuring less than 100 cm2) and 33.3% for large tumors (p less than 0.05).

[Etiology of growth retardation in children of adolescent mothers]. / Etiología del retraso estatural en hijos de adolescentes.

The influence of some nutritional and hormonal factors in the growth failure detected in children of teenage mothers belonging to medium-low socioeconomic level (SEL) was studied. They were compared with children of mothers older than twenty years of the name SEL. Only growth retarded children of teenage mothers had significant delay in bone age, compared with chronological age (14.8 +/- 4.1 vs 18.2 +/- 2.2 months respectively). Children with growth failure had significantly lower plasma Zn (85.7 +/- 13.3 vs 94.6 +/- 17.9 micrograms/dl), Cu (106.2 +/- 32.5 vs 122.0 +/- 13.8 micrograms/dl) and hemoglobin (Hb) (11.7 +/- 2.1 vs 12.8 +/- 2.1 micrograms/dl) levels. No differences in plasmatic levels of thyrotropin, thyroid hormones and response of growth hormone to L-Dopa stimulation were detected in comparison with those of children with normal stature. We concluded that etiological factors of growth failure were similar in children of teenage and adult mothers according to the parameters analyzed. The increased prevalence of growth failure in children of teenage mothers may be due to a greater impact of the analyzed factors.

[Hepatitis A antibodies in children]. / Estudio de anticuerpos de hepatitis A en niños.

With the finding of HBV and HAV, it is possible at the present time to recognize according to its etiology three types of viral hepatitis: type A, Type B and type non-A-non-B. In this paper we have proved that a low socioeconomic status plays a very important role in the spreading of this disease. In a community with a low socioeconomic status, of forty children attending the fourth grade of a primary school, 97 percent were found to have anti-HA: while in a similar group of children with a higher socioeconomic background, we found only 40 per cent of positive cases. A positive sero convertion to anti-HA was found in 90 per cent of the 73 children with acute hepatitis; the remaining 10 per cent were non-A-non-B. A group of 61 children admitted to the L. Calvo Mackenna Children's Hospital with acute or chronic non hepatic disease were studied for anti-HA. We found 77% positive cases in the group of infants under 4 months old; in older infants, a low incidence of anti-HA was observed, but a notorious increase of positive cases was seen after the age of two years, reaching 100 percent of positive cases in children above four years of age. In ten patients studied with prolonged hepatitis, five of them could be possibly classified as having a non-A-non-B hepatitis.