RESUMO
BACKGROUND: We aimed to describe the demand for liver transplantation (LTx) and patient outcomes on the waiting list at the Australian National Liver Transplantation Unit, Sydney over the last 20 years. METHODS: We performed a retrospective analysis with the data divided into three eras: 1985-1993, 1994-2000 and 2001-2008. RESULTS: The number of patients accepted for LTx increased from 320 to 372 and 548 (P < 0.001) with the number of LTx being performed increasing from 262 to 312 and 452 respectively (P < 0.001). The median adult recipient age increased from 45 to 48 and 52 years (P < 0.001) while it decreased in children from 4 to 2 and 1 years respectively (P = 0.001). In parallel, the deceased donor offers decreased from 1003 to 720 and 717 (P < 0.001). Methods to improve access to donor livers have been used with the use of split livers, extended criteria and non-heart beating donors, resulting in increased acceptance of deceased donor offers by 65% and 115% in the second and third eras when compared with the first era (P < 0.001). However, the adult median waiting time has increased from 23 to 41 and 120 days respectively (P < 0.001). This was associated with increased adult mortality on the waiting list from 23 to 40 and 122 respectively (P < 0.001). CONCLUSIONS: Despite the increasing proportion of donor offers being used, the waiting list mortality is increasing. A solution to this problem is an increase in organ donation to keep pace with the escalating demand for LTx.
Assuntos
Transplante de Fígado/mortalidade , Listas de Espera/mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Hepatopatias/mortalidade , Hepatopatias/cirurgia , Transplante de Fígado/tendências , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos , Doadores de Tecidos , Adulto JovemAssuntos
Transplante de Fígado , Doadores de Tecidos/provisão & distribuição , Obtenção de Tecidos e Órgãos , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Idoso , Austrália , Morte Encefálica , Causas de Morte , Transtornos Cerebrovasculares/mortalidade , Criança , Pré-Escolar , Hepatectomia/métodos , Humanos , Pessoa de Meia-Idade , Nova Zelândia , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Ferimentos e Lesões/mortalidadeAssuntos
Neoplasias Encefálicas , Transplante de Órgãos , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Doadores de Tecidos , Adolescente , Adulto , Austrália/epidemiologia , Neoplasias Encefálicas/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de RiscoRESUMO
One hundred patients were referred to the Australian National Liver Transplantation Unit between January 1986 and August 1987. The commonest disorders for referral were chronic active hepatitis in adults (22 cases), fulminant hepatic failure (14), primary biliary cirrhosis (PBC) (12) and primary sclerosing cholangitis (PSC) (10). Of the 100 patients 31 were activated for transplantation while 35 were deferred and 34 were found to be unsuitable. The decision-making in these patients is discussed according to disease category. Timing of transplantation in PBC and PSC seemed clearcut, with 50% of referred patients being activated. However, major difficulties in timing of transplantation were found, particularly in patients with chronic active hepatitis (CAH) and fulminant hepatic failure (FHF). Of 36 patients with CAH (22) or FHF (14) only five were put on the active waiting list and only two were transplanted. Overall, 25 of the 31 patients underwent orthotopic liver transplantation, with 16 alive two-30 months later.
Assuntos
Hepatopatias/cirurgia , Transplante de Fígado , Adulto , Austrália , Criança , Tomada de Decisões , Humanos , Hepatopatias/classificação , Fatores de TempoRESUMO
The Australian National Liver Transplantation Unit carried out 251 multiple organ-retrieval procedures between January 1986 and December 1994: 53% were in the Sydney metropolitan area, 22% in country New South Wales and the Australian Capital Territory, 21% interstate and 4% in New Zealand; mean total procurement times were, respectively, 4 hours 57 minutes, 6 hours 58 minutes, 9 hours 20 minutes and 12 hours 20 minutes. Donor operation times steadily decreased over the nine years. One-year patient and graft survival rates were 77.1% and 70.3%, respectively; primary non-function occurred in only one case. The importance of coordination of donor organ procurement and efficient organ retrieval to the success of transplantation programs is discussed.