P0096 / #565: THE TRAVAILS OF SETTING UP A LIVING DONOR LIVER TRANSPLANT PROGRAM: THE PICU PERSPECTIVES EXPERIENCE FROM TUNISIA

Abstract

Aims & Objectives: To report our first experience of PICU care of living donor liver transplant (LDLT) in Tunisia, and the challenges encountered. Methods: This was a retrospective, descriptive study, collecting the first 10 pediatric LDLT at the Fattouma Bourguiba Hospital between November 2017 and March 2019. Results: The patients average age was 5 years and 11 months. The most common indication of LDLT was cirrhosis complicating PFIC. The average duration of mechanical ventilation was 1.8 days. One child developed hepatic artery thrombosis, another patient developed supra hepatic vein thrombosis. 2 patients developed acute rejection treated with immunosuppressant. The PICU length of stay ranged from 4 to 10 days and there was no ICU mortality. Challenges: - The Creation of liver transplant unit, - The Shortage of nursing staff was addressed by the participation of nurses from pediatric and adult ICU while awaiting the recruitment of more nurses, - The lack of experience of nurses in post- LT care necessitated to send few of them to Necker enfant malades to gain exposure to various aspects of LDLT, - The lack of Pediatric intensivist with expertise in LT was alleviated by the collaboration of pediatric intensivist from France. A daily staff by tele medicine guarantees the continuity of follow-up by the 2 teams. Conclusions: This study marks the successful development of a pediatric LT program in Tunisia. In the developing countries PICU care faces unique challenges in developing LDLT programs. Acknowledgements: We thank Christophe Chardot for his efforts and support in the inception of our transplant program