{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T17:09:32Z","timestamp":1766336972299,"version":"3.48.0"},"reference-count":15,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Over the past 34\u2009years, a single transplant team in S\u00e3o Paulo, Brazil, has performed 1560 pediatric liver transplants (PLT)\u2014including 1352 LDLT, 179 DDT, and 29 domino procedures using donors with maple syrup urine disease\u2014achieving outstanding long\u2010term outcomes. In our most recent cohort of 500 PLT (2018\u20132024), 1\u2010 and 5\u2010year patient survival rates were 96.7% and 94.8%, respectively. From 2015 to 2024, our team performed 35.1% of all PLT in Brazil and 45.5% of those in children under 5\u2009years of age, with 98.1% of the latter using LDLT. This milestone highlights not only clinical achievement but also the persistent structural challenges facing PLT in low\u2010 and middle\u2010income countries. We outline some key barriers to sustainable and equitable PLT development in Brazil, including underfunding, geographic disparities, lack of outcome transparency, bureaucratic delays, and gaps in transition to adult care. A set of guiding principles is proposed to support national progress and inform similar efforts elsewhere. Our center's experience demonstrates that excellence in PLT is achievable in resource\u2010constrained settings, but long\u2010term success depends on institutional commitment, strategic investment, and national coordination to ensure equitable access for all children.<\/jats:p>","DOI":"10.1111\/petr.70221","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T04:40:02Z","timestamp":1762490402000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Building Equity Through Experience: Insights From 1560 Single\u2010Center Pediatric Liver Transplants in a Developing Country"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2267-5386","authenticated-orcid":false,"given":"Jo\u00e3o Seda","family":"Neto","sequence":"first","affiliation":[{"name":"Hepatology and Liver Transplantation Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo Brazil"},{"name":"Liver Transplantation Hospital Samaritano  S\u00e3o Paulo Brazil"},{"name":"Liver Transplantation A. C. Camargo Cancer Center  S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paulo","family":"Chapchap","sequence":"additional","affiliation":[{"name":"Hepatology and Liver Transplantation Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4712-9533","authenticated-orcid":false,"given":"Eduardo A.","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Hepatology and Liver Transplantation Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo Brazil"},{"name":"Liver Transplantation Hospital Samaritano  S\u00e3o Paulo Brazil"},{"name":"Liver Transplantation A. C. Camargo Cancer Center  S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,6]]},"reference":[{"key":"e_1_2_18_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.22000"},{"key":"e_1_2_18_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.25875"},{"key":"e_1_2_18_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001135"},{"key":"e_1_2_18_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14518"},{"key":"e_1_2_18_6_1","doi-asserted-by":"publisher","DOI":"10.1590\/1414\u2010431X20143830"},{"key":"e_1_2_18_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002300"},{"volume-title":"Registro Brasileiro de Transplantes\u2014Relat\u00f3rio Anual 2024","year":"2024","author":"Associa\u00e7\u00e3o Brasileira de Transplante de \u00d3rg\u00e3os (ABTO)","key":"e_1_2_18_8_1"},{"volume-title":"Estat\u00edsticas Sociais\u2014Popula\u00e7\u00e3o","year":"2025","author":"Instituto Brasileiro de Geografia e Estat\u00edstica (IBGE)","key":"e_1_2_18_9_1"},{"volume-title":"Declaration of Istanbul on Organ Trafficking and Transplant Tourism","year":"2018","author":"The Transplantation Society","key":"e_1_2_18_10_1"},{"volume-title":"WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation","year":"2010","author":"World Health Organization","key":"e_1_2_18_11_1"},{"volume-title":"Do No Harm: Legal Advisory and Policy Guidance on Organ Transplantation","year":"2023","key":"e_1_2_18_12_1"},{"key":"e_1_2_18_13_1","unstructured":"Lei N\u00b0 9.434 De 4 De Fevereiro De 1997 \u201cDisp\u00f5e sobre a remo\u00e7\u00e3o de \u00f3rg\u00e3os \u201d(1997) Tecidos e Partes Do Corpo Humano Para Fins de Transplante e Tratamento. Di\u00e1rio Oficial da Uni\u00e3o. Bras\u00edlia DF."},{"key":"e_1_2_18_14_1","unstructured":"Decreto N\u00b0 2.268 de 30 de junho de 1997 \u201cRegulamenta a Lei n\u00b0 9.434\/1997 e cria o Sistema Nacional de Transplantes \u201d(1997) Di\u00e1rio Oficial da Uni\u00e3o Bras\u00edlia DF."},{"volume-title":"Manual T\u00e9cnico de Transplantes e Capta\u00e7\u00e3o de \u00d3rg\u00e3os e Tecidos","year":"2022","author":"Minist\u00e9rio da Sa\u00fade (Brasil)","key":"e_1_2_18_15_1"},{"key":"e_1_2_18_16_1","unstructured":"American Journal of Transplantation 2025 Publication Policies: Ethical Principles in the Use of Human Organs and Tissues"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70221","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T17:07:18Z","timestamp":1766336838000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.70221"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,6]]},"references-count":15,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1111\/petr.70221"],"URL":"https:\/\/doi.org\/10.1111\/petr.70221","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"type":"print","value":"1397-3142"},{"type":"electronic","value":"1399-3046"}],"subject":[],"published":{"date-parts":[[2025,11,6]]},"assertion":[{"value":"2025-10-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70221"}}