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: 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.

Descripción del uso de cápsula endoscópica en un hospital público pediátrico / Description of capsule endoscopy use in a pediatric public hospital

INTRODUCCIÓN: La cápsula endoscópica (CE) es a una técnica no invasiva que permite la visualización de la mucosa del intestino delgado. Se utiliza para el diagnóstico de lesiones no accesibles con otros exámenes. El objetivo fue describir la experiencia de uso de CE en un hospital público pediátrico en Chile. PACIENTES Y MÉTODO: Estudio retrospectivo en que se revisaron los casos en que se utilizó CE en el Hospital Dr. Luis Calvo Mackenna desde 2010 hasta la fecha. Se registraron datos demográficos, clínicos, hallazgos, complicaciones, diagnóstico y conducta. RESULTADOS: Se realizaron 20 procedimientos en 16 pacientes, 11 varones (69%), mediana de edad 12 años (rango 3 a 15 años). Las indicaciones incluyeron estudio de poliposis (60%), sospecha de enfermedad de Crohn (20%), hemorragia digestiva de origen desconocido (15%) y anemia de causa desconocida (5%). Diecisiete estudios estaban alterados (85%) y 11 llevaron a un diagnóstico o cambio de conducta clínica (55%). Los hallazgos principales fueron pólipos y erosiones intestinales. No se produjeron complicaciones. CONCLUSIONES: La CE es una técnica útil y segura en niños, factible de realizar en un hospital público pediátrico.

INTRODUCTION: Capsule endoscopy (CE) is a non-invasive technique that allows visualization of small intestine mucosa. It is used for diagnosis of lesions not accessible with other tests. Our goal was to describe the experience using CE in a pediatric public hospital in Chile. PATIENTS AND METHOD: A retrospective study was carried out to review the cases in which CE was used at Dr. Luis Calvo Mac kenna Hospital from 2010 to date. Demographic and clinical data, findings, complications, diagnosis and treatment were recorded. RESULTS: Twenty procedures were performed in 16 patients, 11 men (69%), median age 12 years (range 3 to 15 years). Indications included polyposis study (60%), suspected Crohn disease (20%), obscure gastrointestinal bleeding (15%) and undiagnosed anemia (5%). Seventeen studies were altered (85%) and 11 led to a diagnosis or clinical behavior change (55%). There were no complications. CONCLUSIONS: CE is a useful and safe technique in children, feasible to perform in a pediatric public hospital.