LIVING RELATED LIVER TRANSPLANTATION. IN WHICH CASES THIS OPTION HAS BEEN DISCARDED IN A PEDIATRIC LIVER TRANSPLANT PROGRAM IN CHILE?:

P713 The technique of Living Related Living Transplantation (LRLT) opened new possibilities for planning transplantation in better conditions for children with emergency situations and chronic liver diseases. In Chile our program was started in 1993, incorporating the technique of LRLT in 1999. Since then, we have performed 17 LRLT in one of the centers belonging to our program, representing a 29, 8%. Actuarial survival in this series is 82, 4% and 74, 1% at 1 and 5 years. During that period more patients could have taken advantage of this innovative technique. For different reasons not all patients in whom LRLT was planned could be transplanted. The aim of this presentation is to analyze the reasons why LRLT was discarded as a therapeutic option. Material and Methods: All pediatrics patients belonging to one of the centers of our program were prospectively included in our Excel database that was reviewed for obtaining information about causes why the LRLT could not be done. Results: During that period LRLT was proposed in 28 cases, LRLT was performed in 17 of them (60, 7%). In 11 cases (39, 3%) this technique could not be used. The reasons for LRLT rejection were parent’s fear to surgical complications in 4 cases (3 fathers and 1 mother), 2 fathers with history of heavy drugs abuse, one mother because she was the only family support, 2 for medical reasons (1 father with fatty liver and one mother with breastfeeding) and only one father discarded for surgical technical reasons (two tiny left arteries). From these eleven cases the indications for liver transplant were acute liver failure (ALF) in 6, biliary atresia in 3 and miscellaneous in 2 cases. Nine were transplanted with cadaveric organs, but two of the patients with ALF died on the waiting list. Conclusions: LRLT is an excellent therapeutic option for acute and chronic terminal liver diseases. Different reasons impede that this therapeutic option could finally be performed. Among them, the most important is parent’s fear to surgery. Technical surgical reasons represent less than 10% of the total. Although most of the patients could finally be transplanted, mortality on waiting list was 33, 3% for patients with ALF. Efforts should be made to clarify any doubts about advantages and disadvantages of lrlt in each single case, allowing parent to take a free, well informed decision.