RESUMEN
INTRODUCTION: Since the early days, liver transplantation (OLT) has conquered several barriers worldwide to become a proven therapy. We assessed the evolution of our adult liver transplant program. METHODS: We studied all adult patients who underwent OLT since the inception from November 1993 through May 2003. Donor data, recipient pretransplantation evaluation, surgical technique, results, and costs were examined over our evolution, stratifying 3 groups over time, based on the number of adult OLT per year. RESULTS: Between November 1993 and May 2003, 70 OLT were performed in 64 patients older than 15 years of age. Preoperative Child score, preoperative creatinine level, donor and recipient age, and proportion of emergencies were similar in the 3 groups. Over time, the predominant surgical technique was the piggyback technique (97% of OLT) with a decrease in the use of bypass from 63% to 5% during the last time period. Over the 10 years of our program's existence, warm ischemia time has been reduced to less than 1 hour, whereas cold ischemia time has remained constant at around 5 hours. Biliary and vascular complications decreased over time to around 10%. The mean length of hospital stay (LOS) decreased to 12 days (excluding emergencies). Since inception, our 1-year patient survival rate average is 91%; however, in just the last 3 years of our program (2000 through 2003), the 1-year patient survival rate is 97%. CONCLUSIONS: In summary, our surgical technique has evolved toward piggyback use without veno-venous bypass with a significant decrease in warm ischemia times. As expected, our results have improved over time and our LOS and costs have decreased. Finally, our current results are similar to the best ones reported in the medical literature today.
Asunto(s)
Trasplante de Hígado/estadística & datos numéricos , Donantes de Tejidos/estadística & datos numéricos , Adulto , Chile , Creatinina/sangre , Humanos , Trasplante de Hígado/métodos , Trasplante de Hígado/fisiología , Resultado del TratamientoRESUMEN
After an initial experience with 4 patients who received orthotopic liver transplant (OLT) we analyze the perspectives of establishing liver transplantation programs in Chile. An estimated 100 adult and pediatric patients require OLT a year and no more than 3 centers are required to deal with this and acquire experience with the procedure. A national organization for organ procurement is essential, given the marked difficulties in obtaining cadaver organs at present. Each procedure has an estimated cost of $5 million with 2 more millions in the first year. Thus a program for 15 patients a year may cost $ 100 million, personnel expenses not included.