Trasplante hepático: Evolución, curva de aprendizaje y resultados después de los primeros 300 casos
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Date
2019
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Abstract
Liver transplantation (LT) is an option for people with liverfailure 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, andto establish our learning curve. Material and Methods: Retrospective cohortstudy with data obtained from a prospectively collected LT Program database.We included all LT performed at a single center from March 1994 to September2017. The database gathered demographics, diagnosis, indications for LT, surgicalaspects and postoperative courses. We constructed a cumulative summation testfor learning curve (LC-CUSUM) using 30-day post-LT mortality. Mortality at 30days, and actuarial 1-, and 5-year survival rate were analyzed. Results: A total of281 patients aged 54 (0-71) years (129 women) underwent 300 LT. Ten percentof patients were younger than 18 years old. The first, second and third indicationsfor LT were non-alcoholic steatohepatitis, chronic autoimmune hepatitis andalcoholic liver cirrhosis, respectively. Acute liver failure was the LT indication in51 cases (17%). The overall complication rate was 71%. Infectious and biliarycomplications were the most common of them (47 and 31% respectively). TheLC-CUSUM curve shows that the first 30 patients corresponded to the learningcurve. The peri-operative mortality was 8%. Actuarial 1 and 5-year survival rateswere 82 and 71.4%, respectively. Conclusions: Outcome improvement of a LTprogram depends on the accumulation of experience after the first 30 transplantsand the peri-operative mortality directly impacted long-term survival.
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Keywords
Learning Curve, Survival Analysis, Liver Transplantation, 610