RESUMO
Background: Renal impairment (RI) is a frequent complication of liver cirrhosis and is associated with increased mortality and morbidity. Liver transplantation (LT) serves as an effective treatment method for patients with cirrhosis who have impaired renal function. However, renal function often declines after LT, influenced by various factors. This study aimed to investigate the factors contributing to RI following LT in our cases. Methods: We analyzed the demographic data, preoperative and perioperative parameters, and postoperative outcomes of patients who underwent LT at the First Central Hospital of Mongolia from September 2011 to December 2022. Renal function was assessed by measuring the glomerular filtration rate using the Cockcroft-Gault creatinine clearance formula pretransplantation and at 24 hours, 72 hours, 7 days, 14 days, and 28 days post-LT. Results: Several factors increased the risk of RI among recipients. These included female sex (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.58-5.91), Child-Turcotte-Pugh (CTP) scores of B and C (OR, 4.23; 95% CI, 0.92-19.41 and OR, 7.68; 95% CI, 1.67-35.30, respectively), preoperative continuous renal replacement therapy (CRRT; OR, 5.86; 95% CI, 1.1-31.21), and a high graft-to-recipient weight ratio (GRWR; OR, 3.45; 95% CI, 1.23-9.63). Additionally, the survival rates for recipients with RI post-LT were 93.4% at 1 year and 78.1% at 3 years. Conclusions: Female sex, a high CTP score, preoperative CRRT, and high GRWR were identified as risk factors for RI after LT in Mongolia.
RESUMO
BACKGROUND: Mongolia introduced liver transplantation 10 years ago, becoming the 46th country globally to successfully perform this procedure. However, the cost of liver transplantation treatment remains expensive in Mongolia, a lower-middle-income country. Thus, the need to calculate the cost of liver transplants, a highly-valued treatment, forms the basis for this study. METHODS: This study employed a retrospective research design with secondary data. The primary dataset comprised 143 cases of liver transplantation performed at the First Central Hospital of Mongolia between 2011 and 2021. RESULTS: The average cost of a liver transplant in Mongolia is $39,589 ± 10,308, with 79.6% being direct costs and 20.4% indirect costs. Of the direct costs, 71% were attributed to drugs, medical equipment, and supplies, while 8.6% accounted for salaries. In terms of the Model of End-Stage Liver Disease (MELD) scores, treatment costs were $39,205 ± 10,786 for patients with MELD ≤ 14 points, $40,296 ± 1,517 for patients with MELD 15-20 points, $39,352 ± 8,718 for patients with MELD 21-27 points, and $39,812 ± 9,954 for patients with MELD ≤ 28 points, with no statistically significant difference (P = 0.953). However, when calculated according to the Child-Turcotte-Pugh (CTP) score classification, treatment cost for CTP-A patients was $35,970 ± 6,879, for CTP-B patients $41,951 ± 12,195, and for CTP-C patients $37,396 ± 6,701, which was statistically significant (Ð =0.015). CONCLUSION: The average cost of liver transplantation treatment in Mongolia was $39,589. Despite medical facilities' capacity to treat up to 50 patients annually, the waiting list exceeds 300 individuals, highlighting significant unmet healthcare needs.