P714 Living Related Liver Transplantation (LRLT) in children is a safe and well documented procedure. Its place in emergency situations has been a topic of discussion. We started a Liver Transplant Program (LTP) in 1993, performing our first pediatric orthotopic liver transplant (OLT) at the end of that year. In 1999, we started a LRLT program, incorporating the right lobe related liver transplant in 2002. The aim of this presentation is to evaluate the role of LRLT in pediatric acute liver failure and other related emergency situations in a LTP in Chile. Material and methods: All our patients were prospectively included in our Excel database that was reviewed for this purpose. Pediatrics cases were differentiated in those transplanted in elective or emergent situations and if LRLT was used or not. Demographics characteristics, indication for OLT and actuarial survival with Kaplan Meier curves were evaluated, Stat View computer program was used for statistical purposes, and p < 0, 05 was considered significant. Results: From a total of 212 OLT, 119 were done in pediatric population. 80 were performed after 1999; 29 (36, 6%) with Liver Related Donor (LRD). 31 (38, 7%) transplants were performed in emergency situation, 20 for acute liver failure and 11 for retransplantation. 15 of them were done with LRD (48, 4%). 49 (61, 3%) patients were transplanted in elective bases 14 of them (28, 5%) with LRD. No complications were found in donors. Actuarial survival at one and five years was 91,7% and 88,9% for patients transplanted electively, and 60,6% and 51,9% for dose transplanted in emergency bases with cadaver donors and 78,8% and 68,9% for patients transplanted with LRD in acute situations (p < 0, 05). Conclusions: LRLT is and excellent option for children that need to be transplanted in emergent situations, allowing transplantation in optimal times, reducing mortality from longer waiting periods, with no complications in donors in this series.
Abstract Background Latin America comprises an extensive and diverse territory composed of 33 countries in the Caribbean, Central, and South America where Romance languages–languages derived from Latin are predominantly spoken. Economic disparities exist, with inequitable access to pediatric surgical care. The Latin American Surgical Outcomes Study in Pediatrics (LASOS‐Peds), a multi‐national collaboration, will determine safety of pediatric anesthesia and perioperative care. Objective Below, we provide a descriptive initiative to share how pediatric anesthesia in Brazil, Chile, and Mexico operate. Theses descriptions do not represent all of Latin America. Descriptions and Conclusions Brazil an upper middle‐income country, population 203 million, has a public system insufficiently resourced and a private system, resulting in inequitable safety and accessibility. Surgical complications constitute the third leading cause of mortality. Anesthesiology residency is 3 years, with required rotations in pediatric anesthesia; five hospitals offer pediatric anesthesia fellowships. Anesthesiology is a physician‐only practice. A Pediatric Anesthesia Committee within the Brazilian Society of Anesthesiology offers education through seasonal courses and workshops including pediatric advanced life support. Chile is a high‐income country, population 19.5 million, the majority cared for in the public system, the remainder in university, private, or military systems. Government efforts have gradually corrected the long‐standing anesthesiology shortage: twenty 3‐year residency programs prepare graduates for routine pediatric cases. The Chilean Society of Anesthesiology runs a 1‐month program for general anesthesiologists to enhance pediatric anesthesia skills. Pediatric anesthesia fellowship training occurs in Europe, USA, and Australia, or in two 2‐year Chilean university programs. Public health policies have increased the medical and surgical pediatric specialists and general anesthesiologists, but not pediatric anesthesiologists, which creates safety concerns for neonates, infants, and medically complex. Chile needs more pediatric anesthesia fellowship programs. Mexico, an upper middle‐income country, with a population of about 126 million, has a five‐sector healthcare system: public, social security for union workers, state for public employees, armed forces for the military, and a private “self‐pay.” There are inequities in safety and accessibility for children. Pediatric Anesthesiology fellowship is 2 years, after 3 years residency. A shortage of pediatric anesthesiologists limits accessibility and safety for surgical care, driven by added training at low salary and hospital under appreciation. The Mexican Society of Pediatric Anesthesiology conducts refresher courses, workshops, and case conferences. Insufficient resources and culture limits research.
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