Advances in medicine reduce the need for pediatric liver transplantation

Said the coordinator of the transplant unit at the Coimbra Hospital and University Center

Improved medical care and new drugs are contributing to the annual reduction in pediatric liver transplants, said the coordinator of the transplant unit at the Centro Hospitalar e Universitário de Coimbra (CHUC), the only one in Portugal.

According to Isabel Gonçalves, responsible for the Pediatric Hepatology and Liver Transplantation Unit (UHTH), which today celebrates 30 years of activity, this is a «positive decrease», which is already observed in the United States of America and in the main centers of Europe and with a “tendency to continue”.

The specialist highlighted to the Lusa agency that the reduction is due «to the fact that the optimization of medical care for chronic diseases has improved a lot over these 30 years and, particularly, in the last 15, new drugs for congenital diseases have appeared on the market, which are probably they will alleviate many of the symptoms and keep these patients much more stable, perhaps until adulthood».

«We will probably transfer many of the indications for transplantation in pediatric age to 30 or 40 years later, already in adulthood. This is an expectation, a prediction and something that we agree on in our European networks when we discuss the matter», he stressed.

On the other hand, Isabel Gonçalves pointed to more medical alternatives in cases of sudden liver failure in healthy children and pediatric intensive care support «completely different from the first 15 years of the transplant program».

“Our goal is to be able to save all children in liver failure, so that they can return to their normal lives with their liver and do not have to be transplanted”, he highlighted.

The UHTH coordinator added that the average number of annual transplants in the only national center was 10 to 12 per year, except for the year 1997 in which 17 were carried out, but that the tendency is to transplant seven to eight per year.

In these 30 years of activity, that unit has performed 307 transplants on 260 children, as some have to be intervened again, and in 2023 nine transplants were carried out.

CHUC's pediatric liver transplant unit receives children and young people from Portuguese-speaking countries (PALOP), which since 1997 represent between 10 and 12% of the total transplants performed, although in recent times the number has also decreased.

The training of elements for transplant teams continues to be, according to Isabel Gonçalves, since the beginning of the unit, a problem and a challenge for low-volume centers such as Coimbra, due to the difficulty in «reconciling expenses with the numbers of activity".

«My biggest concern, which has been going on since the beginning [of the transplant program], is to achieve, with this annual volume, that younger people replace, in four or five years, an older person, who will naturally have to abandon» , he maintained.

The UHTH coordinator highlighted that the authority «has always made a huge effort to ensure that the program effectively does not have limitations of any kind to its normal functioning», but recognizes that «these are investments in health with very high costs and that when a center has more volume has difficulty in providing training».

Over the three decades of its existence, that unit has contributed to improving the quality of life of hundreds of children, many of them adults, as is the case of Fernanda (fictitious name), from Lisbon, aged 40, transplanted at 14 years, due to a congenital disease detected in a baby.

«With the transplant, my quality of life improved, but not immediately, as it takes some adaptation, which takes years, and then I was able to live a normal life, although I have to be careful when the weather is hot or cold, because the immune system became more fragile», he told the Lusa agency.

Fernanda warns of the need for transplant recipients and families to have psychological support after stabilized clinical situations to understand how children and young people and their parents deal with the disease, «whether they accept it, don't accept it or whether they are angry».

Taking his work experience, he also asks for protection at work, so that transplanted people are not passed over in favor of completely healthy workers.

To the children and young people who are about to be transplanted, Fernanda leaves a message of hope in a life that, despite "having ups and downs, will have a quality of life, in general, that has nothing to do" with the situation before the transplant. transplantation, although each person “has to understand how far they can go” in their activities.