Trasplante hepático: evolución, curva de aprendizaje y resultados después de los primeros 300 casos / Liver transplantation: development, learning curve and results after the first 300 cases
Rev. méd. Chile
; 147(8): 955-964, ago. 2019. tab, graf
Article
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| LILACS
| ID: biblio-1058630
Biblioteca responsable:
CL1.1
ABSTRACT
Background:
Liver transplantation (LT) is an option for people with liver failure who cannot be cured with other therapies and for some people with liver cancer.Aim:
To describe, and analyze the first 300 LT clinical results, and to establish our learning curve. Material andMethods:
Retrospective cohort study with data obtained from a prospectively collected LT Program database. We included all LT performed at a single center from March 1994 to September 2017. The database gathered demographics, diagnosis, indications for LT, surgical aspects and postoperative courses. We constructed a cumulative summation test for learning curve (LC-CUSUM) using 30-day post-LT mortality. Mortality at 30 days, and actuarial 1-, and 5-year survival rate were analyzed.Results:
A total of 281 patients aged 54 (0-71) years (129 women) underwent 300 LT. Ten percent of patients were younger than 18 years old. The first, second and third indications for LT were non-alcoholic steatohepatitis, chronic autoimmune hepatitis and alcoholic liver cirrhosis, respectively. Acute liver failure was the LT indication in 51 cases (17%). The overall complication rate was 71%. Infectious and biliary complications were the most common of them (47 and 31% respectively). The LC-CUSUM curve shows that the first 30 patients corresponded to the learning curve. The peri-operative mortality was 8%. Actuarial 1 and 5-year survival rates were 82 and 71.4%, respectively.Conclusions:
Outcome improvement of a LT program depends on the accumulation of experience after the first 30 transplants and the peri-operative mortality directly impacted long-term survival.Palabras clave
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Índice:
LILACS
Asunto principal:
Evaluación de Programas y Proyectos de Salud
/
Trasplante de Hígado
/
Curva de Aprendizaje
Tipo de estudio:
Evaluation_studies
/
Observational_studies
Límite:
Adult
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Aged
/
Female
/
Humans
/
Male
Idioma:
Es
Revista:
Rev. méd. Chile
Asunto de la revista:
MEDICINA
Año:
2019
Tipo del documento:
Article