ABSTRACT
BACKGROUND: In July 2005, Argentina was the first country after the United States to adopt the MELD system. The purpose of the present study was to analyse the impact of this new system on the adult liver waiting list (WL). METHODS: Between 2005 and 2009, 1773 adult patients were listed for liver transplantation: 150 emergencies and 1623 electives. Elective patients were categorized using the MELD system. A prospective database was used to analyse mortality and probability to be transplanted (PTBT) on the WL. RESULTS: The waiting time increased inversely with the MELD score and PTBT positively correlated with MELD score. With scores >/= 18 the PTBT remained over 50%. However, the largest MELD subgroup with <10 points (n = 433) had the lower PTBT (3%). In contrast, patients with T(2) hepatocellular carcinoma benefited excessively with the highest PTBT (84.2%) and the lowest mortality rate (5.4%). The WL mortality increased after MELD adoption (10% vs. 14.8% vs. P < 0.01). Patients with <10 MELD points had >fourfold probability of dying on the WL than PTBT (14.3% vs. 3%; P < 0.0001). CONCLUSIONS: After MELD implementation, WL mortality increased and most patients who died had a low MELD score. A comprehensive revision of the MELD system must be performed to include cultural and socio-economical variables that could affect each country individually.
Subject(s)
Health Status Indicators , Liver Diseases/surgery , Liver Transplantation , Patient Selection , Tissue Donors/supply & distribution , Tissue and Organ Procurement , Waiting Lists , Adolescent , Adult , Aged , Argentina , Chi-Square Distribution , Female , Health Care Rationing , Healthcare Disparities , Humans , Liver Diseases/diagnosis , Liver Diseases/mortality , Liver Transplantation/adverse effects , Liver Transplantation/mortality , Male , Middle Aged , Neoplasm Staging , Predictive Value of Tests , Risk Assessment , Risk Factors , Severity of Illness Index , Time Factors , Treatment Outcome , United States , Waiting Lists/mortality , Young AdultABSTRACT
BACKGROUND AND AIM: Resection of colorectal liver metastases has become a standard of care, although the value of this procedure in non-colorectal non-neuroendocrine (NCRNNE) metastases remains controversial and is still a matter of debate. The aim of the study was to determine the utility of liver resection in the long-term outcome of patients with NCRNNE metastases. MATERIAL AND METHODS: The records of 106 patients who underwent liver resection for NCRNNE metastases in the period 1989 to 2006 at 5 HPB Centers in Argentina were analyzed. Patient demographics, tumor characteristics, type of resection, long-term outcome and prognostic factors were analyzed. Depending on primary tumor sites, a comparative analysis of survival was performed. RESULTS: Mean age was 54 (17-76). Hepatic metastases were solitary in 62.3% and unilateral in 85.6%. Primary tumor sites: Urogenital (37.7%), sarcomas (21.7%), breast (17.9%), gastrointestinal (6.6%), melanoma (5.7%), and others (10.4%). Fifty-one major hepatectomies and 55 minor resections were performed. Twenty patients underwent synchronous resections. An R0 resection could be achieved in 89.6%. Perioperative mortality was 1.8%. Overall, 1-year, 3-year, and 5-year survival rates were 67%, 34%, and 19%, respectively. Survival was significantly longer for metastases of urogenital (p=0.0001) and breast (p=0.003) origin. Curative resections (p=0.04) and metachronous disease (p=0.0001) were predictors of better survival. CONCLUSIONS: Liver resection is an effective treatment for NCRNNE liver metastases; it gives satisfactory long-term survival especially in metachronous disease, in patients with metastases from urogenital and breast tumors and when R0 procedures can be performed.
ABSTRACT
Se comunica la experiencia de trasplante hepático de donante vivo relacionado y el impacto que ha tenido en el programa pediátrico.En el período comprendido entre enero de 1988 y mayo de 1994, se evaluaron para ser trasplantados 174 pacientes menores de 16 años.Ingresaron en lista 76 (48.6 por ciento) y fueron rechazados 12 (6,8 por ciento).De los pacientes aceptados, 38 (50 por ciento) han sido trasplantados y 31 (40,7 por ciento) fallecieron a la espera de un órgano adecuado.en 35 oportunidades el donante fue cadavérico, en 19 seutilizó órgano completo y en 16 la técnica de reducción hepática. Entre los años 92 y 94, luego de una exhaustiva evaluación de 14 donantes, se realizaron 6 trasplantes con donante vivo. En este período 37 pacientes ingresaron en lista de espera, 18 (43,9 por ciento) fueron trasplantados, 6 de ellos (33 por ciento) con donante vivo.La mortalidad disminuyó al 24 por ciento (9 pacientes) en igual período. La sobrevida actuarial anual del total de la serie es del 89 por ciento y del donante vivo del 100 por ciento, con un 83 por ciento de sobrevida del injerto.Tres pacientes fueron retrasplantados . El trasplante hepático con donante vivo es un procedimiento alternativo, que permite paliar la escasa oferta de donantes y disminuir la mortalidad en los candidatos de bajo peso
Subject(s)
Clinical Evolution , Liver Transplantation , PediatricsABSTRACT
Se comunica la experiencia de trasplante hepático de donante vivo relacionado y el impacto que ha tenido en el programa pediátrico.En el período comprendido entre enero de 1988 y mayo de 1994, se evaluaron para ser trasplantados 174 pacientes menores de 16 años.Ingresaron en lista 76 (48.6 por ciento) y fueron rechazados 12 (6,8 por ciento).De los pacientes aceptados, 38 (50 por ciento) han sido trasplantados y 31 (40,7 por ciento) fallecieron a la espera de un órgano adecuado.en 35 oportunidades el donante fue cadavérico, en 19 seutilizó órgano completo y en 16 la técnica de reducción hepática. Entre los años 92 y 94, luego de una exhaustiva evaluación de 14 donantes, se realizaron 6 trasplantes con donante vivo. En este período 37 pacientes ingresaron en lista de espera, 18 (43,9 por ciento) fueron trasplantados, 6 de ellos (33 por ciento) con donante vivo.La mortalidad disminuyó al 24 por ciento (9 pacientes) en igual período. La sobrevida actuarial anual del total de la serie es del 89 por ciento y del donante vivo del 100 por ciento, con un 83 por ciento de sobrevida del injerto.Tres pacientes fueron retrasplantados . El trasplante hepático con donante vivo es un procedimiento alternativo, que permite paliar la escasa oferta de donantes y disminuir la mortalidad en los candidatos de bajo peso