In Latin America, liver transplants for children are uncommon, due to the lack of professional teams trained for this operation. A course at Garrahan Hospital, sponsored by PAHO, aims to change this situation

Buenos Aires, Argentina, 10 October 2019 (PAHO/WHO) - “This has been a very enriching experience. The objective now is to go back to my country and help create a program that performs this kind of operation,” said Daniel Vargas, an Ecuadorian surgeon, who participated in the first course on pediatric liver transplants at Garrahan Hospital in Buenos Aires, Argentina.

Transplant liver surgery
All photos: Department of Communication, Garrahan Hospital.

Vargas and 50 other health professionals from all over Latin America took part in the training, which concluded with a live transmission of a transplant, a highly complex procedure that took 10 hours and more than 80 professionals in two operating rooms.

Since graduating as a surgeon in his native Ecuador, Vargas has lived in Buenos Aires for over a year and is currently a fellow at the liver transplantation unit at Garrahan Hospital, a regional facility of reference.

“During the course, the doctors answered all our questions,” said Vargas. “All this knowledge is applicable, especially the surgical techniques. It will surely have an impact on outcomes in other institutions.”

Surgeons, pediatricians, gastroenterologists, and hepatologists from Argentina, Bolivia, Brazil, Ecuador, Paraguay, Peru, and Uruguay took the course in late May this year. The course was organized by the Pan American Health Organization/World Health Organization (PAHO/WHO) in coordination with the National Central Coordinating Institute for Ablations and Implants (INCUCAI), a PAHO/WHO Collaborating Center.

“Authorization by PAHO/WHO to give this course shows that we have the capacity and knowledge to perform pediatric liver transplants and to transmit our knowledge to other countries in the region that are still not performing this procedure on young patients,” said Oscar Imventarza, head of Garrahan’s liver transplantation unit, who led the training.

Transplant liver surgery

This Argentine surgeon, a pioneer in the development of the specialty, added: “It was very enriching for all of us because, although it is a very complex surgery, seeing it done makes you realize that, with the right experience and training, it can be quite simple.”

Surgery livestreamed

“When it occurred to us to wrap the course up with an actual surgery, we realized it was impossible to fit 50 people into an operating room. So we decided to livestream the entire procedure, which, by the way, was being performed in two different hospitals,” explained Imventarza.

An 11-month-old girl with liver disease received a small piece of her mother’s liver at Argerich Hospital, in another part of the city. The organ was then transferred to Garrahan, where it was transplanted. Both patients recovered well following the operations.

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Guido Aguirre, an intensive care pediatrician who travelled from Paraguay specifically to attend the course, explained that, “In our country, we are not performing this type of intervention and all liver transplant cases are sent to Garrahan. Being here is huge progress for us and is pretty historic. In the future, we hope to create a group that will begin doing liver transplants in Paraguay.”

Imventarza highlighted that all the participants in the course “are receiving our support to begin developing their liver transplantation programs, so that they do not feel they have to do it alone. We are also looking into the possibility of offering more specific courses for surgeons and therapists, in order to maintain ties and ensure the creation of more trained teams in the region.”

More than 800 pediatric liver transplants

Liver transplantation is the treatment of choice for terminal acute or chronic pediatric patients without an effective alternative. Garrahan Hospital has been performing this procedure since 1992, with more than 40 transplants a year with survival rates that meet world standards. To date, the hospital has performed over 800 liver transplants in children, about half the total for the entire country.

Transplant liver surgery

The course given in Buenos Aires is in line with a strategy and plan of action to increase access to transplantation services, approved at PAHO’s 57th Directing Council, which is made up of the Ministers of Health of the countries of the Americas. The strategy aims to develop health workers’ competencies through training programs such as the course offered at Garrahan.

MERCOSUR, the Argentinean Ministry of Health, and Institute of Transplantation of the City of Buenos Aires also collaborated in organizing the course.


Video: First liver transplant course (Garrahan Hospital)
Video: About the course (Garrahan Hospital)