Situación actual del trasplante hepático pediátrico por hepatopatías crónicas en Chile: Inequidades asociadas a la priorización por sistema MELD/PELD
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:...
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| Lenguaje: | Spanish / Castilian |
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Sociedad Médica de Santiago
2020
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| Acceso en línea: | http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000901261 |
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oai:scielo:S0034-988720200009012612020-12-26Situación actual del trasplante hepático pediátrico por hepatopatías crónicas en Chile: Inequidades asociadas a la priorización por sistema MELD/PELDDíaz,Luis AntonioLópez,MarisolSin,PriscilaWolff,RodrigoGonzález,GloriaMuñoz,María PazUribe,MarioAnanias,ÁlvaroBezama,IgnacioZañartu,NicolásBuckel,ErwinInnocenti,FrancoPattillo,Juan CarlosJarufe,NicolásMartínez,JorgeGuerra,Juan FranciscoElgueta,SusanaGana,Juan Cristóbal Liver Diseases Living Donors Liver Transplantation Resource Allocation Waiting Lists 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.info:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.148 n.9 20202020-09-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000901261es10.4067/S0034-98872020000901261 |
| institution |
Scielo Chile |
| collection |
Scielo Chile |
| language |
Spanish / Castilian |
| topic |
Liver Diseases Living Donors Liver Transplantation Resource Allocation Waiting Lists |
| spellingShingle |
Liver Diseases Living Donors Liver Transplantation Resource Allocation Waiting Lists Díaz,Luis Antonio López,Marisol Sin,Priscila Wolff,Rodrigo González,Gloria Muñoz,María Paz Uribe,Mario Ananias,Álvaro Bezama,Ignacio Zañartu,Nicolás Buckel,Erwin Innocenti,Franco Pattillo,Juan Carlos Jarufe,Nicolás Martínez,Jorge Guerra,Juan Francisco Elgueta,Susana Gana,Juan Cristóbal Situación actual del trasplante hepático pediátrico por hepatopatías crónicas en Chile: Inequidades asociadas a la priorización por sistema MELD/PELD |
| description |
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. |
| author |
Díaz,Luis Antonio López,Marisol Sin,Priscila Wolff,Rodrigo González,Gloria Muñoz,María Paz Uribe,Mario Ananias,Álvaro Bezama,Ignacio Zañartu,Nicolás Buckel,Erwin Innocenti,Franco Pattillo,Juan Carlos Jarufe,Nicolás Martínez,Jorge Guerra,Juan Francisco Elgueta,Susana Gana,Juan Cristóbal |
| author_facet |
Díaz,Luis Antonio López,Marisol Sin,Priscila Wolff,Rodrigo González,Gloria Muñoz,María Paz Uribe,Mario Ananias,Álvaro Bezama,Ignacio Zañartu,Nicolás Buckel,Erwin Innocenti,Franco Pattillo,Juan Carlos Jarufe,Nicolás Martínez,Jorge Guerra,Juan Francisco Elgueta,Susana Gana,Juan Cristóbal |
| author_sort |
Díaz,Luis Antonio |
| title |
Situación actual del trasplante hepático pediátrico por hepatopatías crónicas en Chile: Inequidades asociadas a la priorización por sistema MELD/PELD |
| title_short |
Situación actual del trasplante hepático pediátrico por hepatopatías crónicas en Chile: Inequidades asociadas a la priorización por sistema MELD/PELD |
| title_full |
Situación actual del trasplante hepático pediátrico por hepatopatías crónicas en Chile: Inequidades asociadas a la priorización por sistema MELD/PELD |
| title_fullStr |
Situación actual del trasplante hepático pediátrico por hepatopatías crónicas en Chile: Inequidades asociadas a la priorización por sistema MELD/PELD |
| title_full_unstemmed |
Situación actual del trasplante hepático pediátrico por hepatopatías crónicas en Chile: Inequidades asociadas a la priorización por sistema MELD/PELD |
| title_sort |
situación actual del trasplante hepático pediátrico por hepatopatías crónicas en chile: inequidades asociadas a la priorización por sistema meld/peld |
| publisher |
Sociedad Médica de Santiago |
| publishDate |
2020 |
| url |
http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000901261 |
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