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Díaz LA, López M, Sin P, Wolff R, González G, Muñoz MP, Uribe M, Ananias Á, Bezama I, Zañartu N, Buckel E, Innocenti F, Pattillo JC, Jarufe N, Martínez J, Guerra JF, Elgueta S, Gana JC. [Current situation of pediatric liver transplantation in Chile. Inequities associated with the MELD/PELD prioritization system]. Rev Med Chil 2021; 148:1261-1270. [PMID: 33399701 DOI: 10.4067/s0034-98872020000901261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/14/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Chilean allocation system for liver transplantation (LT) uses the MELD/PELD score to prioritize candidates on the waiting list. AIM To assess if the Chilean allocation system for LT is equitable for pediatric candidates compared to their adult counterparts. MATERIAL AND METHODS We used the Public Health Institute's registry between October 2011 and December 2017. We analyzed candidates with chronic hepatic diseases listed for LT. The primary outcome was the cadaveric liver transplantation (CLT) rate. Secondary outcomes were death or disease progression in the waiting list and living donor liver transplant (LDLT) rate. RESULTS We analyzed 122 pediatric and 735 adult candidates. Forty one percent of pediatric candidates obtained a CLT compared to 48% of adults (p = NS). Among patients aged under two years of age, the access to CLT on the waiting list there was 28% of CLT, compared to 48% in adults (p = 0.001). Fifty-seven percent of candidates aged under two years were listed for cholestatic diseases, obtaining a CLT in 18% and requiring a LDLT in 49%. The median time in the waiting list for CLT was 5.9 months in pediatric candidates and 5.1 in adults, while the median time to death in the waiting list was 2.8 and 5.6 months, respectively. The mortality rate at one year in candidates under two years old was 38.1% compared to 32.5% in adults. CONCLUSIONS Pediatric candidates with chronic liver diseases, especially under two years of age, have greater access difficulties to CLT than adults. Half of the pediatric candidates die on the waiting list before three months. The mortality among candidates under two years of age in the waiting list is excessively high.
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Affiliation(s)
- Luis Antonio Díaz
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marisol López
- Departamento de Pediatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Priscila Sin
- División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Wolff
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Mario Uribe
- Hospital Dr. Luis Calvo Mackenna, Santiago, Chile
| | - Álvaro Ananias
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ignacio Bezama
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Zañartu
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Juan Carlos Pattillo
- División de Cirugía, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Jorge Martínez
- División de Cirugía, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Francisco Guerra
- MedStar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington D.C., Estados Unidos de Norteamérica
| | | | - Juan Cristóbal Gana
- División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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