Deaths and complications among children undergoing liver transplants increased between 2019 and 2023

Of the 22 children who received liver transplants between June 2019 and August 2023, 9.1% died in the operating room (two patients) and 13.6% (three patients) died afterward. Carlos Jiménez Herrera, medical director of the National Children’s Hospital, told the Audit Office that between 2016 and June 2019, no transplant patient died.

Additionally, 59.1% of transplanted minors had to undergo surgery again due to postoperative complications between June 2019 and August 2023. This equates to 13 out of 22 transplanted patients. In comparison, from 2016 to June 2019, only 11.1% of 18 transplanted minors (2) needed to return to the operating room due to complications.

According to the audit report, of the 22 liver transplant operations between 2019 and 2023, only four children survived the operation without serious complications; five died and 13 became complicated.

been: Children’s National Hospital to restart living donor liver transplants

Among the findings from last June’s ASALUD-0019-2024 report, which investigated the management of the fund’s liver transplant program, the Children’s National (HNN) findings stood out.

The report showed that the CCSS at the time had neither medical management authority nor responsibility for donation and transplant coordination. Jose Pablo Garbanzo Corrales, They adhere to the institutional board’s protocol for cadaveric and living donor pediatric liver transplants.

Garbanzo is also the only pediatric transplant surgeon to perform operations at Children’s Hospital from 2019 to 2023, during which time he also served as CCSS transplant coordinator. The surgeon served from November 2019 to Oct. 31. He replaces José Andrés Madrigal Bustamante.

One of the 2015 and 2019 board agreements that ordered the Children’s Hospital and the Mexican hospital’s hepatobiliary surgery teams to jointly perform these transplants was violated.

been: It takes two years for CCSS to transplant a liver from a living donor

nation He tried to find Garbanzo on his phone to refer to the matter. He received two text messages on his WhatsApp, one on the morning of Tuesday, July 30, and another on the morning of Wednesday, July 31. In addition, a direct call was made to his phone, but only the voicemail was activated.

Gaps in Pediatric Liver Transplant Care

According to the audit report, the decision to exclude pediatric liver transplant specialists from Mexican hospitals resulted in disparities in care and treatment coverage between the pediatric population and the adult population.

While adults have access to specialist medical care year-round, the same is not true for children.

Having only one surgeon at Children’s Hospital had several consequences for the audit:

• International standards dictate that multiple experts must be involved in the selection, evaluation and decision-making process for which pediatric patients with end-stage liver disease should be considered candidates for liver transplantation and placed on national waiting lists so that the decision-making has an ethical and scientific balance. At Children’s Hospital, only one surgeon was responsible for these processes.
• To date, complications in pediatric patients are being managed by a pediatric liver transplant specialist.

• Since Garbanzo Corrales is the only pediatric surgeon who specializes in liver transplants, he is also the only one who can provide available insurance coverage for 15 days per month to care for complications that may arise before and after a patient’s transplant. According to the audit, this means that six months of each year, the group of children do not receive services from a pediatric liver transplant specialist. He attributes this to exclusions by the Mexican hospital team.
• The clinical decision to reject a liver transplant offer was made by a single medical professional, without a second criterion as required by international standards.

been: Parents of children awaiting liver transplants ask CCSS for solutions

• Garbanzo Corrales is the only specialist in transplants using cadaveric donors. There are at least two such hospitals for adults.
• Garbanzo was also the only one to select living patients and evaluate the portions of the liver to be removed.

nation The Medical Director of Children’s National Hospital was consulted about the situation. However, he did not mention the audit report because he had not been formally communicated.

Jose Andre Madrigal, institutional coordinator of the institution’s donation and transplant program, said they will continue to analyze the results of pediatric liver transplants based on the audit’s recommendations and that they have contacted the hospital about this.

He said that in this analysis it is important to determine how to strengthen human resource planning. According to Madrigal, the National Children’s School already conducts rotations abroad, especially in Argentina.

“In any project, we always believe there is room for improvement. In this case, based on the audit report, we will focus on the children’s hospital so that it can do more transplants and achieve better results,” the official declared.

The scenario contemplates the involvement of transplant teams at Mexican hospitals. However, Madrigal believes that collaboration in pediatric liver transplantation should be institutionalized and utilize the entire network.