Results of the National Program of Liver Transplantation in Uruguay 10 years after it was initiated
DOI:
https://doi.org/10.29193/RMU.36.4.2Keywords:
LIVER TRANSPLANTATION, SURVIVAL, QUALITY IMPROVEMENT, QUALITY INDICATORS, URUGUAYAbstract
Introduction: liver transplantation constitutes the first therapy chosen by patients with severe and irreversible liver conditions, when no effective alternative options are available. Measurement of quality indicators allow for the detection of problems that may be solved in order to optimize results.
Objective: to present the results obtained in the National Program of Liver Transplantation in Uruguay, 10 years after its implementation and to compare them to international quality standards.
Method: retrospective study of liver transplantations performed from July 14, 2009 through July 14, 2019.
Results: N: 190 Liver transplantations (LT). Average age: 45 years old. Gender: 60% male. MELD average MELD (Model for End-stage Liver Disease) upon LT: 21. Main indications: cirrhosis he(59%) y hepatocarcinoma (21%). Post-surgery mortality: 7.4% and peri-operative mortality 2.1% (standards <10 and 1%). Re-transplantation rate: early 3.7% and late 4.2% (standards <5% and 8%). Reoperation rate: 13.1% (standard <10%) and of non-primary function: 2.6% (standard <2%). Survival: 86.6% per year, 81.8% after 3 years, 77.4% after 5 and 63.2% after 10 years (standards >80, 75, 70 and 60%). Patients assessed in less than 30 days: 47% (standard >75%). Non-implanted livers with no objective cause rate: 0.5% (standard <1%). 86% of users stated they were satisfied (standard >80%). Mortality in the waiting list: 19% (standard <15%). Early mortality with functioning liver: 1% (standard <1%).
Conclusions: national Program of Liver Transplantation in Uruguay meets most quality indicators standards, evidencing survival results that are above international standards.
References
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(26) España. Organización Nacional de Transplante. Registro Español de Trasplante Hepático. Memoria de resultados 2016. Disponible en: www.ont.es/infesp/Registros/Memoria%20RETH%202016_GENERAL.pdf [Consulta: 3 setiembre 2018].
(27) Prieto J, Medina J, López M, Rando K, Iglesias C, Harguindeguy M, et al. Impact of a multimodal approach in prevention of surgical site infection in hepatic transplant recipients. Transplant Proc 2016; 48:658-64.
(28) Prieto J, Lopez M, Medina J, Gemelli S. Baja mortalidad por enfermedades oportunistas en el programa nacional de trasplante hepático. Montevideo. Uruguay. Rev Urug Med Inter 2019; 1:144.
(29) Gavalda J, Meije Y, Fortún J, Roilides E, Saliba F, Lortholary O, et al. Invasive fungal infections in solid organ transplant recipients. Clin Microbiol Infect 2014; 20(Suppl 7):27-48.
(30) Prieto J, Medina JC. Encuesta latinoamericana sobre diagnóstico de hepatitis por Citomegalovirus en pacientes receptores de trasplante hepático. (Sección poster). En: XXIV Congreso Latinoamericano y del Caribe de Trasplante. Montevideo-Uruguay, setiembre 2017.
(2) National Institutes of Health Consensus Development Conference Statement: liver transplantation—June 20-23, 1983. Hepatology 1984; 4(1 Suppl):107S-110S.
(3) European Association for the Study of the Liver. EASL Clinical Practice Guidelines for: liver transplantation. J Hepatol 2016; 64(2):433-85.
(4) Fondo Nacional de Recursos. Trasplante hepático en adultos. Normativa de cobertura. Montevideo: FNR, 2016. Disponible en: http://www.fnr.gub.uy/sites/default/files/normativas/tecnicas/n_tras_hepatico.pdf [Consulta: 16 febrero 2020].
(5) Ettlin A, Rando A, Harguindeguy M, Leites A, Gerona S, Castelli, et al. Programa de trasplante hepático en Uruguay: análisis y resultados. Salud Mil 2011; 30(1):27-38.
(6) Rando K, Harguindeguy M, Leites A, Ettlin A, González S, Scalone P, et al. Quality standars in liver surgery: influence of multidisciplinary team work and patient centralization. Acta Gastroenterol Latinoam 2010; 40(1):10-21.
(7) Gerona S, Rando K, Harguindeguy M, Scalone P, Castelli J, Greco G, et al. Consolidation of a National Program of Liver Transplantation in Uruguay: from the bench side to the goverment involvement. Liver Transpl 2010; 16(S1).
(8) Mathur AK, Talwalkar J. Quality measurement and improvement in liver transplantation. J Hepatol 2018; 68:1300-10.
(9) Herrero JI, Sociedad Española de Trasplante Hepático. III Consensus Meeting of the Spanish Society of Liver Transplantation. Hepatitis C, living-donor liver transplantation, quality of liver grafts and of liver transplantation programs. Gastroenterol Hepatol 2011; 34(9):641-59.
(10) Prieto J, López M, Medina J. Citomegalovirus: 9 años de experiencia en el programa nacional de trasplante hepático. Montevideo. Uruguay. Rev Urug Med Inter 2019; (1):145.
(11) Cabeza E, Medina J, Prieto J, López M. Protocolo de profilaxis y auditoria permitió una disminución significativa de las infecciones fúngicas invasivas por Aspergillus spp y Cándida spp en el Programa Nacional de Trasplante Hepático-Uruguay. Rev Urug Med Inter 2019; (1):147.
(12) Hosmer DW, Lemeshow S. Applied survival analysis: regression modeling of time-to-event data. New York: John Wiley, 1999.
(13) R Core Team 2017. A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Disponible en: https://www.R-project.org/ [Consulta:16 febrero 2020].
(14) Varona MA, Soriano A, Aguirre-Jaime A, Barrera MA, Medina ML, Bañon N, et al. Statistical quality control charts for liver transplant process indicators: evaluation of a single-center experience. Transplant Proc 2012; 44:1517-22.
(15) Uemura T, Randall HB, Sanchez EQ, Ikegami T, Narasimhan G, McKenna GJ, et al. Liver retransplantation for primary nonfunction: analysis of a 20-year single-center experience. Liver Transpl 2007; 13 (2):227-33.
(16) Ploeg RJ, D’Alessandro AM, Knechtle SJ, Stegall MD, Pirsch JD, Hoffmann RM, et al. Risk factors for primary dysfunction after liver transplantation—a multivariate analysis. Transplantation 1993; 55 (4):807-13.
(17) Makowka L, Gordon RD, Todo S, Ohkohchi N, Marsh JW, Tzakis AG, et al. Analysis of donor criteria for the prediction of outcome in clinical liver transplantation. Transplant Proc 1987; 19(1 Pt3):2378-82.
(18) Sirivatanauksorn Y, Taweerutchana V, Limsrichamrern S, Kositamongkol P, Mahawithitwong P, Asavakarn S, et al. Recipient and perioperative risk factors associated with liver transplant graft outcomes. Transplant Proc 2012; 44(2):505-8.
(19) Mikolasevic I, Milic S, Filipec-Kanizaj T. Fatty liver allografts are associated with primary graft non-function and high mortality after transplantation. Liver Int 2017; 37(8):1113-5.
(20) Mainardi V, Rando K, Olivari D, Rey G, Castelli J, Grecco G, et al. Mortality analysis of acute liver failure in Uruguay. Transplant Proc 2018; 50:465-71.
(21) Instituto Nacional de Donación y Trasplante de Células, Tejidos y Órganos. Estadísticas (actualizadas a diciembre 2019). Trasplante de Órganos y Tejidos. Disponible en: https://www.indt.gub.uy/?S=estadisticas [Consulta: 24 marzo 2020].
(22) Organ Procurement & Transplantation Network. Allocation Calculators. Disponible en: https://optn.transplant.hrsa.gov › allocation-calculators [Consulta: 24 marzo 2020].
(23) Freeman RB, Wiesner RH, Edwards E, Harper A, Merion R, Wolfe R; United Network for Organ Sharing Organ Procurement and Transplantation Network Liver and Transplantation Committee. Results of the first year of the new liver allocation plan. Liver Transpl 2004; 10:7-15.
(24) Cejas NJ, Villamil FG, Lendoire JC, Tagliafichi V, Lopez A, Hansen Krogh D, et al. Improved waiting-list outcomes in Argentina after the adoption of a model for end-stage liver disease–based liver allocation policy. Liver Transpl 2013; 19:711-20.
(25) Sociedad de Trasplantes de América Latina y el Caribe. Latin America Transplantation Registry Report 2015-2016. Disponible en: https://www.stalyc.net/registros.html [Consulta: 27 diciembre 2018].
(26) España. Organización Nacional de Transplante. Registro Español de Trasplante Hepático. Memoria de resultados 2016. Disponible en: www.ont.es/infesp/Registros/Memoria%20RETH%202016_GENERAL.pdf [Consulta: 3 setiembre 2018].
(27) Prieto J, Medina J, López M, Rando K, Iglesias C, Harguindeguy M, et al. Impact of a multimodal approach in prevention of surgical site infection in hepatic transplant recipients. Transplant Proc 2016; 48:658-64.
(28) Prieto J, Lopez M, Medina J, Gemelli S. Baja mortalidad por enfermedades oportunistas en el programa nacional de trasplante hepático. Montevideo. Uruguay. Rev Urug Med Inter 2019; 1:144.
(29) Gavalda J, Meije Y, Fortún J, Roilides E, Saliba F, Lortholary O, et al. Invasive fungal infections in solid organ transplant recipients. Clin Microbiol Infect 2014; 20(Suppl 7):27-48.
(30) Prieto J, Medina JC. Encuesta latinoamericana sobre diagnóstico de hepatitis por Citomegalovirus en pacientes receptores de trasplante hepático. (Sección poster). En: XXIV Congreso Latinoamericano y del Caribe de Trasplante. Montevideo-Uruguay, setiembre 2017.
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Published
2020-12-01
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Mainardi V, Menéndez J, Valverde M, San Martín G, Prieto J, Noceti O, et al. Results of the National Program of Liver Transplantation in Uruguay 10 years after it was initiated. Rev. Méd. Urug. [Internet]. 2020 Dec. 1 [cited 2024 Nov. 22];36(4):341-53. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/639
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