Pediatric Liver Transplantation in South America: Incidence and Indications

Introduction

South America currently has approximately 430,485,637 inhabitants, 16.2% of whom are under the age of 18. Brazil is the most populous South American country (213,106,000 people), followed by Colombia and Argentina (48,106,000 and 47,106,000 people, respectively). Economic resources vary widely, with most South Americans having a low or mid-range income. As an example of the disparity, the gross domestic product at purchasing power parity per capita is 3219 billion USD in Brazil but only 68 billion USD in Paraguay.

The first liver transplantation (LT) in South America was performed in 1968 in Brazil on an adult patient. This procedure improved the prospects of patients with highly complex liver diseases. The first living donor LT (LDLT) in the world was performed in 1988 in São Paolo. The following text will describe pediatric LT (PLT) indications and features in several South American countries.

Liver Transplantation and Liver Transplantation Centers in South America

The number of LTs has progressively increased over the past 10 years in most of the countries listed in the Latin American and Caribbean Transplant Registry. LT is now performed in 15 Latin American countries, including 17 centers that have medical facilities fully dedicated to LT. There are currently more than 160 transplantation teams in Latin America, mostly in Brazil (42 centers), followed by Mexico (15 centers), Argentina (12 centers), Colombia (7 centers), and Chile (6 centers). Only eight Latin American countries have official records of PLTs: Brazil, Argentina, Mexico, Chile, Colombia, Peru, Venezuela, and Cuba.

A worldwide list of the 20 countries performing the most LTs per million people (pmp) includes only two Latin American countries (Argentina and Brazil). In Latin America, the mean annual number of effective donations is 8.3 pmp (range, 0 to > 20 pmp). The family refusal rate for organ donation ranges from approximately 30% in Uruguay to 70% in Peru. In Uruguay, Argentina, Cuba, and some parts of Brazil, the number of yearly donations currently exceeds 15 pmp, whereas in other Latin American countries, deceased donor organs are not routinely used.

Despite major economic improvements in South America, its healthcare industry is still underdeveloped. Some South American countries (e.g., Argentina, Brazil, Chile, and Uruguay) provide universal public healthcare with full coverage, including immunosuppressive drugs. Other South American countries offer only partial coverage for medical treatments such as LT. Lack of or inadequate healthcare coverage is considered the main barrier to LT in South America.

Local transplantation-related activities are handled by organizations usually directly linked to the ministry of health in each Latin American country. Most of these countries have organ procurement organizations, with national laws that include the fulfillment of specific criteria for the diagnosis of brain death and the acquisition of informed or presumed consent for organ retrieval. Due to difficulties in obtaining deceased donors for pediatric patients, more than 30 Latin American centers offer LDLTs. LDLTs in Latin America are mainly restricted to pediatric patients, particularly those who would otherwise require deceased donors weighing less than 10 kg. Surgical techniques such as split, domino, and living donor adult and PLT are now routinely performed in several countries.

Liver Transplantation in Various South American Countries